Provider Demographics
NPI:1801173935
Name:ELFORD, LARRY DALE (DC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:DALE
Last Name:ELFORD
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 1:2400 VETERANS BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3136
Mailing Address - Country:US
Mailing Address - Phone:830-488-6105
Mailing Address - Fax:
Practice Address - Street 1:2400 VETERANS BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3136
Practice Address - Country:US
Practice Address - Phone:830-488-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor