MEDICARE: LARRY G WRIGHT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	04553	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114987492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY G WRIGHT D.C.

Provider Business Mailing Address
First Line	:	115 E MAIN
Second Line	:	PO BOX 488
City	:	DENVER
State	:	IA
Zip	:	50622-0488
Country	:	US
Telephone Number	:	319-984-5829
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E MAIN
Second Line	:
City	:	DENVER
State	:	IA
Zip	:	50622-0488
Country	:	US
Telephone Number	:	319-984-5829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/02/2007

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