Provider Demographics
NPI:1124089198
Name:PHIPPS, LARRY E
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WESTWOOD DR
Mailing Address - Street 2:BOX 1446
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5153
Mailing Address - Country:US
Mailing Address - Phone:641-752-1010
Mailing Address - Fax:
Practice Address - Street 1:105 WESTWOOD DR
Practice Address - Street 2:BOX 1446
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5153
Practice Address - Country:US
Practice Address - Phone:641-752-1010
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17045Medicare ID - Type Unspecified