Provider Demographics
NPI:1760752604
Name:LARRY G. MCGLOTHLIN, PC
Entity Type:Organization
Organization Name:LARRY G. MCGLOTHLIN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:MCGLOTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-384-1631
Mailing Address - Street 1:3012 FOREST HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2312
Mailing Address - Country:US
Mailing Address - Phone:434-384-1631
Mailing Address - Fax:434-384-7932
Practice Address - Street 1:3012 FOREST HILLS CIR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2312
Practice Address - Country:US
Practice Address - Phone:434-384-1631
Practice Address - Fax:434-384-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000303261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21418Medicare UPIN
VA350000003Medicare PIN