Larry Vaughn Sutherland, DC
Individual provider Active NPI Chiropractor · Blissfield, MI
NPI 1952307654 · NPPES record last updated May 11, 2011
Key facts
- NPI
- 1952307654
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- LS004601 (MI)
- Practice address
- 120 E Adrian St
Box D
Blissfield, MI 49228-1254 - Phone
- (517) 486-3008
- Fax
- (517) 486-5669
- NPI assigned
- Jun 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LS004601 | MI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | LS004601 | MI | Yes |
Addresses
Primary practice location
120 E Adrian St
Box D
Blissfield, MI 49228-1254
Mailing address
301 E Jefferson St
Blissfield, MI 49228-1325
Phone (517) 486-3492
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 769311 | Other | MI | FIRST HEALTH |
| 04128 | Other | MA | PARAMOUNT |
Other providers in Blissfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.