Provider Demographics
NPI:1124156880
Name:ANDERSON, LARRY GENE (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GENE
Last Name:ANDERSON
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 1:44130 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3527
Mailing Address - Country:US
Mailing Address - Phone:661-948-5988
Mailing Address - Fax:
Practice Address - Street 1:7 MELGROVE LN
Practice Address - Street 2:STE 101
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2275
Practice Address - Country:US
Practice Address - Phone:573-248-1393
Practice Address - Fax:573-248-2189
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000032354Medicare PIN
MOT17643Medicare UPIN