Provider Demographics
NPI:1891825238
Name:DEGARMEAUX, LARRY WAYNE (DC DOCTOR OF CHIROPR)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WAYNE
Last Name:DEGARMEAUX
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
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 214
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038
Mailing Address - Country:US
Mailing Address - Phone:304-845-8828
Mailing Address - Fax:304-845-8801
Practice Address - Street 1:605 LAFAYETTE AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041
Practice Address - Country:US
Practice Address - Phone:304-845-8828
Practice Address - Fax:304-845-8801
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
W32067Medicare UPIN