Provider Demographics
NPI:1306042239
Name:LARGENT, MICHELLE A (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:LARGENT
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 1:1350 E 9TH ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7395
Mailing Address - Country:US
Mailing Address - Phone:530-456-1457
Mailing Address - Fax:530-230-3811
Practice Address - Street 1:1350 E 9TH ST
Practice Address - Street 2:SUITE 190
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7395
Practice Address - Country:US
Practice Address - Phone:530-456-1457
Practice Address - Fax:530-230-3811
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034747111N00000X
CADC-31455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA44338721Medicare UPIN