Provider Demographics
NPI:1336159201
Name:NAYLOR, LARRY DALLAS (DC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:DALLAS
Last Name:NAYLOR
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:TRUFANT
Mailing Address - State:MI
Mailing Address - Zip Code:49347-0157
Mailing Address - Country:US
Mailing Address - Phone:616-984-5200
Mailing Address - Fax:616-984-5293
Practice Address - Street 1:220 C STREET
Practice Address - Street 2:
Practice Address - City:TRUFANT
Practice Address - State:MI
Practice Address - Zip Code:49347-0157
Practice Address - Country:US
Practice Address - Phone:616-984-5200
Practice Address - Fax:616-984-5293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILN007256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E95011OtherBLUE CROSS
950E950110OtherBCBSM PIN
MI0E95011OtherBLUE CROSS
950E950110OtherBCBSM PIN