Provider Demographics
NPI:1285766352
Name:ESTEBO, LARRY LEE (DC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:LEE
Last Name:ESTEBO
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 1:1545 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:FALCON HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6316
Mailing Address - Country:US
Mailing Address - Phone:651-487-2198
Mailing Address - Fax:651-646-0283
Practice Address - Street 1:1545 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113-6316
Practice Address - Country:US
Practice Address - Phone:651-487-2198
Practice Address - Fax:651-646-0283
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1948111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic