Provider Demographics
NPI:1174534424
Name:LARIMORE, MICHAEL L (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:LARIMORE
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 1:630 15TH AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-772-3100
Mailing Address - Fax:303-651-2556
Practice Address - Street 1:630 15TH AVE
Practice Address - Street 2:STE 102
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-772-3100
Practice Address - Fax:303-651-2556
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08044141Medicaid
CO46543Medicare ID - Type Unspecified
U27557Medicare UPIN