Provider Demographics
NPI:1881618775
Name:NOBLE, LARRIS ROY (DC)
Entity type:Individual
Prefix:DR
First Name:LARRIS
Middle Name:ROY
Last Name:NOBLE
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 1:1701 YUCCA LN
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5639
Mailing Address - Country:US
Mailing Address - Phone:620-342-6071
Mailing Address - Fax:
Practice Address - Street 1:2708 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6341
Practice Address - Country:US
Practice Address - Phone:620-342-3188
Practice Address - Fax:620-342-5208
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20-5068325OtherTAX ID NUMBER