Organization Active NPI

Larger Than Life Chiropractic

  • Chiropractor
  • Macon, GA
National Provider Identifier
1710343447
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR008931 Issued in GA
Legal business name
LARGER THAN LIFE CHIROPRACTIC
Practice address
4931 Riverside Dr Ste 300a
Macon, GA 31210-1168
Phone
(478) 257-6114
Fax
(478) 238-5415
NPI assigned
Jan 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Dr. Dusty Large, D.C.NPI 1396016648
Title
Owner
Phone
(478) 257-6114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIR008931 GA Primary

Addresses

Primary practice location

4931 Riverside Dr Ste 300a
Macon, GA 31210-1168

Mailing address

4931 Riverside Dr Ste 300a
Macon, GA 31210-1168
Phone (478) 257-6114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160307000693 GA Part B Supplier - Clinic/Group Practice 9335445022 Receives reassigned benefits from 2 practitioners
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Locations

4931 Riverside Dr
Ste 300A
Macon, GA 31210
Phone (478) 257-6114

3040 Riverside Dr
Ste B3
Macon, GA 31210
Phone (478) 257-6114

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1710343447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4931 RIVERSIDE DR STE 300A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101168",
            "telephone_number": "478-257-6114",
            "fax_number": "478-238-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4931 RIVERSIDE DR STE 300A",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312101168",
            "telephone_number": "478-257-6114",
            "fax_number": "478-238-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARGER THAN LIFE CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-11",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "LARGE",
        "authorized_official_first_name": "DUSTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-257-6114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.