Provider Demographics
NPI:1700963766
Name:BALMER, LARRY A (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:A
Last Name:BALMER
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 1:10404 BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2743
Mailing Address - Country:US
Mailing Address - Phone:952-884-0498
Mailing Address - Fax:952-888-7563
Practice Address - Street 1:10700 NORMANDALE BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2700
Practice Address - Country:US
Practice Address - Phone:952-888-5805
Practice Address - Fax:952-888-7563
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39741Medicare UPIN