Provider Demographics
NPI:1457809683
Name:LARKS CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:LARKS CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:LARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-494-4444
Mailing Address - Street 1:2225 WILLIAMS TRACE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4513
Mailing Address - Country:US
Mailing Address - Phone:281-494-4444
Mailing Address - Fax:281-494-2117
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4513
Practice Address - Country:US
Practice Address - Phone:281-494-4444
Practice Address - Fax:281-494-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605014Medicare PIN