Provider Demographics
NPI:1710343447
Name:LARGER THAN LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:LARGER THAN LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:478-257-6114
Mailing Address - Street 1:4931 RIVERSIDE DR STE 300A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1168
Mailing Address - Country:US
Mailing Address - Phone:478-257-6114
Mailing Address - Fax:478-238-5415
Practice Address - Street 1:4931 RIVERSIDE DR STE 300A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1168
Practice Address - Country:US
Practice Address - Phone:478-257-6114
Practice Address - Fax:478-238-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty