Provider Demographics
NPI:1548383326
Name:LARSEN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:LARSEN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF CHIROPRACT
Authorized Official - Phone:765-472-1127
Mailing Address - Street 1:7 N WABASH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2224
Mailing Address - Country:US
Mailing Address - Phone:765-472-1127
Mailing Address - Fax:765-472-5228
Practice Address - Street 1:7 N WABASH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2224
Practice Address - Country:US
Practice Address - Phone:765-472-1127
Practice Address - Fax:765-472-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001019A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092330OtherANTHEM WELLPOINT
IN000000092330OtherANTHEM WELLPOINT