Individual provider Active NPI

Larry Edward Burrell, D.C.

  • Chiropractor
  • Chesterfield, MO
National Provider Identifier
1922054188
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6502 Issued in MO
Practice address
4 West Dr
Suite 100
Chesterfield, MO 63017-1793
Phone
(636) 536-3622
Fax
(636) 536-2039
NPI assigned
May 26, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6502 MO Primary

Addresses

Primary practice location

4 West Dr
Suite 100
Chesterfield, MO 63017-1793

Mailing address

4 West Dr
Suite 100
Chesterfield, MO 63017-1793
Phone (636) 536-3622

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6502MOMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Chiropractic LLC Chiropractor PastSince Jun 1, 2003 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922054188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 WEST DR",
            "address_2": "SUITE 100",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630171793",
            "telephone_number": "636-536-3622",
            "fax_number": "636-536-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 WEST DR",
            "address_2": "SUITE 100",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630171793",
            "telephone_number": "636-536-3622",
            "fax_number": "636-536-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURRELL",
        "first_name": "LARRY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "6502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.