Healthcare Provider Details

I. General information

NPI: 1255330056
Provider Name (Legal Business Name): LARRY L. STINE D.C., F.A.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 REDWOOD DR
FREDERICKSBURG VA
22408-1945
US

IV. Provider business mailing address

117 REDWOOD DR
FREDERICKSBURG VA
22408-1945
US

V. Phone/Fax

Practice location:
  • Phone: 540-898-4100
  • Fax: 540-898-9004
Mailing address:
  • Phone: 540-898-4100
  • Fax: 540-898-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number0104000612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: