Provider Demographics
NPI:1538433644
Name:LARRY HUTCHISON DC PC
Entity type:Organization
Organization Name:LARRY HUTCHISON DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-384-3002
Mailing Address - Street 1:1103 MADISON AVE N
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2803
Mailing Address - Country:US
Mailing Address - Phone:912-384-3002
Mailing Address - Fax:912-383-4691
Practice Address - Street 1:1103 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2803
Practice Address - Country:US
Practice Address - Phone:912-384-3002
Practice Address - Fax:912-383-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008878111N00000X
GACHIR001282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty