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General NPI Number Information
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NPI Number | 1851556450
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Entity Type | Organization
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Legal Business Name | LARRY E BURRELL, DC, LLC
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 4 WEST DR SUITE 100
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City | CHESTERFIELD
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State | MO
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Zip | 63017-1793
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Country | US
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Telephone | 636-536-3622
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Fax | 636-536-2039
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Provider Business Mailing Address
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Address Line | 4 WEST DR SUITE 100
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City | CHESTERFIELD
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State | MO
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Zip | 63017-1793
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Country | US
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Telephone | 636-536-3622
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Fax | 636-536-2039
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Authorized Official
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Title or Position | MEMBER
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Name | DR. LARRY EDWARD BURRELL
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Credential | D.C.
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Telephone | 636-536-3622
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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 | 6502
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License Number State | MO
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