Provider Demographics
NPI:1811063456
Name:LARRAGOITE, LAWRENCE JASON (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JASON
Last Name:LARRAGOITE
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 1:4937 SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:623-330-1414
Mailing Address - Fax:
Practice Address - Street 1:4937 SHEFFIELD PL
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9242
Practice Address - Country:US
Practice Address - Phone:623-330-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7399111N00000X
IA080802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0939880OtherBCBS
AZ664336OtherUNITED HEALTH CARE
AZ77722Medicare ID - Type Unspecified
AZAZ0939880OtherBCBS