Provider Demographics
NPI:1144560145
Name:PANNELL, LARRY (LAC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:PANNELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10709 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1631
Mailing Address - Country:US
Mailing Address - Phone:509-466-9008
Mailing Address - Fax:509-466-0175
Practice Address - Street 1:10709 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1631
Practice Address - Country:US
Practice Address - Phone:509-466-9008
Practice Address - Fax:509-466-0175
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60317337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist