Provider Demographics
NPI:1225187149
Name:LARSEN CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:LARSEN CHIROPRACTIC, PLLC
Other - Org Name:BRIAN M. LARSEN, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-943-4919
Mailing Address - Street 1:507 KNIGHT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4258
Mailing Address - Country:US
Mailing Address - Phone:509-943-4919
Mailing Address - Fax:509-578-1012
Practice Address - Street 1:507 KNIGHT ST
Practice Address - Street 2:SUITE B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4258
Practice Address - Country:US
Practice Address - Phone:509-943-4919
Practice Address - Fax:509-578-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227613OtherLABOR & INDUSTRIES
WA8869872Medicare PIN