Provider Demographics
NPI:1710900519
Name:LIBS, LARRY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:LIBS
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 1:3228 N 109TH PL
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-8908
Mailing Address - Country:US
Mailing Address - Phone:517-270-2704
Mailing Address - Fax:517-270-2704
Practice Address - Street 1:3228 N 109TH PL
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109
Practice Address - Country:US
Practice Address - Phone:517-263-6181
Practice Address - Fax:517-263-6181
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005437111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-2837719OtherCOMMERCIAL INSURANCE
MI950D611170OtherBCBSM
MI1958864Medicaid
MI0C35224Medicare ID - Type UnspecifiedMEDICARE ID