Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC007458L | PA |
NPI | 1053399956 |
---|---|
Provider Name | Dr. Larry Mccracken JR. |
First Address | Johnstown, PA 15904-1424 |
Second Address | Johnstown, PA 15904-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 14/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81746 | (02) | PA |