Provider Demographics
NPI:1902897234
Name:HAMBERLIN, LARRY WAYNE (DC, PHD, NP-C)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
Last Name:HAMBERLIN
Suffix:
Gender:M
Credentials:DC, PHD, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:809 W. NASH, STE. A
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0033
Mailing Address - Country:US
Mailing Address - Phone:972-563-1475
Mailing Address - Fax:972-524-5132
Practice Address - Street 1:809 W NASH ST
Practice Address - Street 2:STE. A
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2557
Practice Address - Country:US
Practice Address - Phone:972-563-1475
Practice Address - Fax:972-524-5132
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX774755363LF0000X
TX8248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020836-01Medicaid
TX1959676OtherFIRST HEALTH
TX21206450531-01OtherBEECHSTREET
TX7616077OtherAETNA
TX10030732OtherAMERIGROUP
TX0059145OtherBLUELINK
13877OtherPARKLAND
89705OtherAMERICAID
432141OtherASHN
TX7616077OtherAETNA
TX1959676OtherFIRST HEALTH
TX0059145OtherBLUELINK