Provider Demographics
NPI:1689780140
Name:MASULA, LARRY ERNEST (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ERNEST
Last Name:MASULA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PHILADELPHIA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4932
Mailing Address - Country:US
Mailing Address - Phone:530-342-6441
Mailing Address - Fax:530-342-5441
Practice Address - Street 1:30 PHILADELPHIA DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4932
Practice Address - Country:US
Practice Address - Phone:530-342-6441
Practice Address - Fax:530-342-5441
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11770111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT04481Medicare UPIN
CADC0117700Medicare ID - Type Unspecified