Provider Demographics
NPI:1912126830
Name:BARRETT, LARRY EDWARD (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:EDWARD
Last Name:BARRETT
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S 43RD ST
Mailing Address - Street 2:STE 120
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5404
Mailing Address - Country:US
Mailing Address - Phone:425-271-8321
Mailing Address - Fax:425-271-1110
Practice Address - Street 1:401 S 43RD ST
Practice Address - Street 2:STE 120
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5404
Practice Address - Country:US
Practice Address - Phone:425-271-8321
Practice Address - Fax:425-271-1110
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU47338Medicare UPIN