Provider Demographics
NPI:1114260031
Name:LARSON, ANNIKA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNIKA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2360
Mailing Address - Country:US
Mailing Address - Phone:701-837-1020
Mailing Address - Fax:
Practice Address - Street 1:1020 N BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2360
Practice Address - Country:US
Practice Address - Phone:701-837-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor