Provider Demographics
NPI:1568598613
Name:LARSEN, KURT ALLEN (DC,)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ALLEN
Last Name:LARSEN
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 1:4303 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-9475
Mailing Address - Country:US
Mailing Address - Phone:501-623-9355
Mailing Address - Fax:
Practice Address - Street 1:4303 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-9475
Practice Address - Country:US
Practice Address - Phone:501-623-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1022111NI0900X, 111NN0400X, 111NN1001X, 111NP0017X, 111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59506Medicare ID - Type UnspecifiedPROVIDER PART B