Provider Demographics
NPI:1790994416
Name:VANSUCH, LARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:VANSUCH
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 1:2240 MORSE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5821
Mailing Address - Country:US
Mailing Address - Phone:614-428-9310
Mailing Address - Fax:614-428-9407
Practice Address - Street 1:2240 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5821
Practice Address - Country:US
Practice Address - Phone:614-428-9310
Practice Address - Fax:614-428-9407
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003594Medicaid