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General NPI Number Information
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NPI Number | 1639383607
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Entity Type | Individual
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Provider Name | LARRY DEVINE D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 13416 N 32ND ST SUITE 107
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City | PHOENIX
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State | AZ
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Zip | 85032-6000
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Country | US
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Telephone | 602-393-7654
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12632
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City | SCOTTSDALE
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State | AZ
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Zip | 85267-2632
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Country | US
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Telephone | 480-332-3400
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5208
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | B-570
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License Number State | NV
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