Provider Demographics
NPI:1710018502
Name:LARRY E. WILKINS,, P.C.
Entity Type:Organization
Organization Name:LARRY E. WILKINS,, P.C.
Other - Org Name:LAUREL MOUNTAIN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-547-5030
Mailing Address - Street 1:372 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666
Mailing Address - Country:US
Mailing Address - Phone:724-547-5030
Mailing Address - Fax:724-547-8306
Practice Address - Street 1:372 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666
Practice Address - Country:US
Practice Address - Phone:724-547-5030
Practice Address - Fax:724-547-8306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA060092Medicare PIN