Provider Demographics
NPI:1306871611
Name:LOPEZ, LARRY CHRISTOPHER (DOCTOR OF CHIROPRACT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:CHRISTOPHER
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513
Mailing Address - Country:US
Mailing Address - Phone:925-634-1101
Mailing Address - Fax:925-634-1156
Practice Address - Street 1:232 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513
Practice Address - Country:US
Practice Address - Phone:925-634-1101
Practice Address - Fax:925-634-1156
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16601111N00000X
CAAC13269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T06202Medicare UPIN