Healthcare Provider Details

I. General information

NPI: 1497740419
Provider Name (Legal Business Name): LARRY J KLEEFELD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 H ST
ARCATA CA
95521-6342
US

IV. Provider business mailing address

604 H ST
ARCATA CA
95521-6342
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-5188
  • Fax: 707-822-8465
Mailing address:
  • Phone: 707-822-5188
  • Fax: 707-822-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: