Provider Demographics
NPI:1295989499
Name:MANN, LARRY W (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:MANN
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 1:5328 REIMERS RD
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6139
Mailing Address - Country:US
Mailing Address - Phone:512-789-6266
Mailing Address - Fax:
Practice Address - Street 1:5328 REIMERS RD
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6139
Practice Address - Country:US
Practice Address - Phone:512-789-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT-92497OtherTEXAS PROVIDER NUMBER