Provider Demographics
NPI:1801199419
Name:LAROCK, WILFORD CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:WILFORD
Middle Name:CHARLES
Last Name:LAROCK
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 1:6330 N MESA ST
Mailing Address - Street 2:STE D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4564
Mailing Address - Country:US
Mailing Address - Phone:915-875-0050
Mailing Address - Fax:
Practice Address - Street 1:6330 N MESA ST
Practice Address - Street 2:STE D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4564
Practice Address - Country:US
Practice Address - Phone:915-875-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor