Provider Demographics
NPI:1962689851
Name:WHITAKER, LARRY NEAL (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NEAL
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 LOUETTA ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:281-370-4251
Mailing Address - Fax:281-370-1695
Practice Address - Street 1:6518 LOUETTA ROAD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:281-370-4251
Practice Address - Fax:281-370-1695
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H5031OtherBLUE CROSS BLUE SHIELD
TX8H5031OtherBLUE CROSS BLUE SHIELD