Provider Demographics
NPI:1669529012
Name:NORRIS, LARRY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6749 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3574
Mailing Address - Country:US
Mailing Address - Phone:269-324-3131
Mailing Address - Fax:269-329-2983
Practice Address - Street 1:6749 S WESTNEDGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3574
Practice Address - Country:US
Practice Address - Phone:269-324-3131
Practice Address - Fax:269-329-2983
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C96411OtherBLUE CROSS BLUE SHIELD
MIG04627OtherBLUE CARE NETWORK
MI0C964110Medicare ID - Type UnspecifiedMEDICARE