Provider Demographics
NPI:1912183351
Name:STEFFENSMEIER, LARRY ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ALLEN
Last Name:STEFFENSMEIER
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 1:215 WINSTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5727
Mailing Address - Country:US
Mailing Address - Phone:307-382-3090
Mailing Address - Fax:307-362-1024
Practice Address - Street 1:215 WINSTON DRIVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5727
Practice Address - Country:US
Practice Address - Phone:307-382-3090
Practice Address - Fax:307-362-1024
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY507111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1407758OtherUNITED MINE WORKERS
WY1407758OtherUNITED MINE WORKERS
WYW302846Medicare PIN