Provider Demographics
NPI:1043559867
Name:BURKS, LARRY THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:THOMAS
Last Name:BURKS
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 1:15800 UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4085
Mailing Address - Country:US
Mailing Address - Phone:503-597-8352
Mailing Address - Fax:
Practice Address - Street 1:15800 UPPER BOONES FERRY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4085
Practice Address - Country:US
Practice Address - Phone:503-597-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor