Provider Demographics
NPI:1497842389
Name:LARSON, ZACHARY GILBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:GILBERT
Last Name:LARSON
Suffix:
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 1:18556 PILOT KNOB RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8674
Mailing Address - Country:US
Mailing Address - Phone:651-428-2247
Mailing Address - Fax:651-463-2007
Practice Address - Street 1:18556 PILOT KNOB RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-8674
Practice Address - Country:US
Practice Address - Phone:651-428-2247
Practice Address - Fax:651-463-2007
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor