Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIA-993 | ID |
NPI | 1003985045 |
---|---|
Provider Name | Larry W Hammond |
First Address | Moscow, ID 83843-3063 |
Second Address | Moscow, ID 83843-3063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 23/09/2015 |