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General NPI Number Information
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NPI Number | 1255330056
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Entity Type | Individual
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Provider Name | LARRY L. STINE D.C., F.A.C.O.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 12/16/2023
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Provider Practice Location Address
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Address Line | 117 REDWOOD DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-1945
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Country | US
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Telephone | 540-898-4100
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Fax | 540-898-9004
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Provider Business Mailing Address
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Address Line | 117 REDWOOD DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-1945
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Country | US
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Telephone | 540-898-4100
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Fax | 540-898-9004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 0104000612
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License Number State | VA
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