Provider Demographics
NPI:1801990957
Name:MCILROY, LARRY D (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:D
Last Name:MCILROY
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-0459
Mailing Address - Country:US
Mailing Address - Phone:806-894-8119
Mailing Address - Fax:806-894-2796
Practice Address - Street 1:111 JOHN DUPREE DR
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336
Practice Address - Country:US
Practice Address - Phone:806-894-8119
Practice Address - Fax:806-894-2796
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5763 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1574915-01Medicaid
TX8G5930OtherBLUE CROSS
TX8G5930OtherBLUE CROSS
TX8A0243Medicare PIN