Provider Demographics
NPI:1588634604
Name:LARSEN, DANIEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:5630 MEMORIAL AVE N STE 1
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-1087
Mailing Address - Country:US
Mailing Address - Phone:651-439-2712
Mailing Address - Fax:651-439-2663
Practice Address - Street 1:5630 MEMORIAL AVE N
Practice Address - Street 2:STE 1
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-1087
Practice Address - Country:US
Practice Address - Phone:651-439-2712
Practice Address - Fax:651-439-2663
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor