Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2301005437 | MI |
NPI | 1710900519 |
---|---|
Provider Name | Dr. Larry Lee Libs |
First Address | Kansas City, KS 66109-8908 |
Second Address | Kansas City, KS 66109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1958864 | (05) | MI |
38-2837719 | COMMERCIAL INSURANCE (01) | MI |
950D611170 | BCBSM (01) | MI |