Provider Demographics
NPI:1194095836
Name:LARRY C GANS CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:LARRY C GANS CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-774-9887
Mailing Address - Street 1:665 S KNICKERBOCKER DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1059
Mailing Address - Country:US
Mailing Address - Phone:408-774-9887
Mailing Address - Fax:408-736-6656
Practice Address - Street 1:665 S KNICKERBOCKER DR STE 3
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1059
Practice Address - Country:US
Practice Address - Phone:408-774-9887
Practice Address - Fax:408-736-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22529261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49249Medicare UPIN