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NPI Code Detail

MEDICARE: DR. LARRY MCCRACKEN JR. D.C.

MEDICARE: DR. LARRY MCCRACKEN JR. D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician ChiropractorDC007458LPA

General Provider Information

NPI Number : 1053399956
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY MCCRACKEN JR. D.C.
Provider Business Mailing Address
First Line : 2519 BEDFORD ST
Second Line :
City : JOHNSTOWN
State : PA
Zip : 15904-1424
Country : US
Telephone Number : 814-266-3226
Fax Number : 814-262-0656
Provider Business Practice Location Address
First Line : 2519 BEDFORD ST
Second Line :
City : JOHNSTOWN
State : PA
Zip : 15904-1424
Country : US
Telephone Number : 814-266-3226
Fax Number : 814-262-0656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 01/14/2008

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