Provider Demographics
NPI:1740617950
Name:CALDWELL, LARRY PAUL (DOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:PAUL
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 1ST ST S STE 260
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7606
Mailing Address - Country:US
Mailing Address - Phone:952-930-3633
Mailing Address - Fax:
Practice Address - Street 1:810 1ST ST S STE 260
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7606
Practice Address - Country:US
Practice Address - Phone:952-930-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist