Provider Demographics
NPI:1851556450
Name:LARRY E BURRELL, DC, LLC
Entity Type:Organization
Organization Name:LARRY E BURRELL, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-536-3622
Mailing Address - Street 1:4 WEST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1793
Mailing Address - Country:US
Mailing Address - Phone:636-536-3622
Mailing Address - Fax:636-536-2039
Practice Address - Street 1:4 WEST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1793
Practice Address - Country:US
Practice Address - Phone:636-536-3622
Practice Address - Fax:636-536-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU05670Medicare UPIN
MO000031523Medicare PIN