Clinton Lariscy, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3355 Illinois St
Recruit Training Command Great Lakes
Great Lakes, IL 60088

Phone

(847) 688-4643

NPI assigned

Jul 29, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280361600000",
    "number": "1164736302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 ILLINOIS ST",
            "address_2": "RECRUIT TRAINING COMMAND GREAT LAKES",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "60088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 ILLINOIS ST",
            "address_2": "RECRUIT TRAINING COMMAND GREAT LAKES",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "60088",
            "telephone_number": "847-688-4643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARISCY",
        "first_name": "CLINTON",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-29",
        "last_updated": "2010-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Koder, PTA
• Seth David Koerner, RPH
• Claire Kubiesa, PH.D.
• Glenn A Kurtz, DDS
• Kelly Robert Lanning, DMD
• Lauren Jayne Lattery, OD, MS
• Don D Lavanway, RPH
• Elinor Grace Layton, DMD
• Marisa Leandro, D.D.S., M.S.
• Daria Hyeri Lee, D.D.S.

• Independent Duty Corpsman in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Independent Duty Corpsman in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.