Healthcare Provider Details

I. General information

NPI: 1902897234
Provider Name (Legal Business Name): LARRY WAYNE HAMBERLIN D.C., PH.D, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W NASH ST STE. A
TERRELL TX
75160-2557
US

IV. Provider business mailing address

PO BOX 1866 809 W. NASH, STE. A
TERRELL TX
75160-0033
US

V. Phone/Fax

Practice location:
  • Phone: 972-563-1475
  • Fax: 972-524-5132
Mailing address:
  • Phone: 972-563-1475
  • Fax: 972-524-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number774755
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8248
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: