Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 04363 | IA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 04363 | IA |
NPI | 1124016746 |
---|---|
Provider Name | Dr. Larry D Hirschy |
First Address | Chariton, IA 50049-1835 |
Second Address | Chariton, IA 50049-1835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 18/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0130773 | (05) | IA |
T00819 | (02) |