Provider Demographics
NPI:1932332202
Name:HALTERS, LARRY ALLEN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:HALTERS
Suffix:JR
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 1:11010 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-9287
Mailing Address - Country:US
Mailing Address - Phone:419-659-2176
Mailing Address - Fax:419-659-2176
Practice Address - Street 1:11010 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-9287
Practice Address - Country:US
Practice Address - Phone:419-659-2176
Practice Address - Fax:419-659-2176
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3017603Medicaid
OH4277414Medicare PIN
OH3017603Medicaid
OH4277413Medicare PIN