Provider Demographics
NPI:1558338855
Name:ADAIR, LARRY DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:DOUGLAS
Last Name:ADAIR
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 11182
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401
Mailing Address - Country:US
Mailing Address - Phone:423-752-7464
Mailing Address - Fax:423-752-6079
Practice Address - Street 1:920 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2724
Practice Address - Country:US
Practice Address - Phone:423-752-7464
Practice Address - Fax:423-752-6079
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3973851Medicaid
TN3973851Medicaid
3973851Medicare ID - Type Unspecified