MEDICARE: LARRY D LAUDENBACK DC

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	3595	OK

General Provider Information

NPI Number	:	1598831448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY D LAUDENBACK DC

Provider Business Mailing Address
First Line	:	4322 E 66TH ST
Second Line	:	SUITE 3I
City	:	TULSA
State	:	OK
Zip	:	74136-1667
Country	:	US
Telephone Number	:	918-798-5500
Fax Number	:	918-439-0222

Provider Business Practice Location Address
First Line	:	913 N 161ST E AVE
Second Line	:	SUITE E
City	:	TULSA
State	:	OK
Zip	:	74116
Country	:	US
Telephone Number	:	918-672-2734
Fax Number	:	918-439-0222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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Directions to “ LARRY D LAUDENBACK DC” Practice Location

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