Individual
DR. LARRY B VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
916 TALON DRIVE, SUITE 102, OFALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Mailing address
916 TALON DRIVE, SUITE 102, OFALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038003709
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08220357
BCBS GRP#
IL
01
—
900068033
TAX ID#
IL
Enumeration date
08/02/2006
Last updated
01/07/2008
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