Provider Demographics
NPI:1053399956
Name:MCCRACKEN, LARRY JR (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:MCCRACKEN
Suffix:JR
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 1:2519 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1424
Mailing Address - Country:US
Mailing Address - Phone:814-266-3226
Mailing Address - Fax:814-262-0656
Practice Address - Street 1:2519 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1424
Practice Address - Country:US
Practice Address - Phone:814-266-3226
Practice Address - Fax:814-262-0656
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007458L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU81746Medicare UPIN