Provider Demographics
NPI:1255402509
Name:HERRING, LARRY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MICHAEL
Last Name:HERRING
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 1:15817 BERNARDO CENTER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2322
Mailing Address - Country:US
Mailing Address - Phone:858-674-7200
Mailing Address - Fax:858-674-7277
Practice Address - Street 1:15817 BERNARDO CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2322
Practice Address - Country:US
Practice Address - Phone:858-674-7200
Practice Address - Fax:858-674-7277
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT54835Medicare UPIN