Healthcare Provider Details

I. General information

NPI: 1710900519
Provider Name (Legal Business Name): LARRY LEE LIBS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 N 109TH PL
KANSAS CITY KS
66109
US

IV. Provider business mailing address

3228 N 109TH PL
KANSAS CITY KS
66109-8908
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-6181
  • Fax: 517-263-6181
Mailing address:
  • Phone: 517-270-2704
  • Fax: 517-270-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2301005437
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: