MEDICARE: LARRY HAWKINS D.C., P.A.

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1346905130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY HAWKINS D.C., P.A.

Provider Business Mailing Address
First Line	:	6655 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-1507
Country	:	US
Telephone Number	:	561-707-8212
Fax Number	:	561-206-0601

Provider Business Practice Location Address
First Line	:	6655 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-1507
Country	:	US
Telephone Number	:	561-707-8212
Fax Number	:	561-206-0601

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ANGELA POULOS
Credential	:
Telephone Number	:	561-707-8212

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	11/05/2021

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