MEDICARE: DR. KEVIN J LARKS 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	DC 4351	TX

General Provider Information

NPI Number	:	1396853982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN J LARKS D.C.

Provider Business Mailing Address
First Line	:	2225 WILLIAMS TRACE BLVD
Second Line	:	STE 102
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4440
Country	:	US
Telephone Number	:	281-494-4444
Fax Number	:	281-494-2117

Provider Business Practice Location Address
First Line	:	2225 WILLIAMS TRACE BLVD
Second Line	:	STE 102
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4440
Country	:	US
Telephone Number	:	281-494-4444
Fax Number	:	281-494-2117

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/22/2016

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