Provider Demographics
NPI:1457652869
Name:LARSON, MICHAEL R (ND,DC,LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:LARSON
Suffix:
Gender:M
Credentials:ND,DC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 CARNATION DUVALL RD NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-6706
Mailing Address - Country:US
Mailing Address - Phone:206-679-1957
Mailing Address - Fax:425-788-3831
Practice Address - Street 1:9316 CARNATION DUVALL RD NE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-6706
Practice Address - Country:US
Practice Address - Phone:206-679-1957
Practice Address - Fax:425-788-3831
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 00000712111N00000X
WAAC 00000398171100000X
WANT 00000534175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist