Provider Demographics
NPI:1720170699
Name:PACEY, LARRY J (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:PACEY
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 1:306 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-3923
Mailing Address - Country:US
Mailing Address - Phone:620-326-3611
Mailing Address - Fax:620-326-6939
Practice Address - Street 1:306 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-3923
Practice Address - Country:US
Practice Address - Phone:620-326-3611
Practice Address - Fax:620-326-6939
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005486OtherBLUE CROSS BLUE SHIELD
KS005486Medicare ID - Type Unspecified
KS005486OtherBLUE CROSS BLUE SHIELD