Healthcare Provider Details

I. General information

NPI: 1932283280
Provider Name (Legal Business Name): LARRY M LEGUNN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CAMINO GARDENS BLVD SUITE 101
BOCA RATON FL
33432-5824
US

IV. Provider business mailing address

333 CAMINO GARDENS BLVD SUITE 101
BOCA RATON FL
33432
US

V. Phone/Fax

Practice location:
  • Phone: 561-417-8383
  • Fax: 561-417-8383
Mailing address:
  • Phone: 561-417-8383
  • Fax: 561-417-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH002538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: