Provider Demographics
NPI:1699811141
Name:TRUSTY LARSEN, JENNIFER JANE (DC, MBM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:TRUSTY LARSEN
Suffix:
Gender:F
Credentials:DC, MBM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HABITAT CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6196
Mailing Address - Country:US
Mailing Address - Phone:970-674-1508
Mailing Address - Fax:970-225-1392
Practice Address - Street 1:222 HABITAT CIR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-6196
Practice Address - Country:US
Practice Address - Phone:970-674-1508
Practice Address - Fax:970-225-1392
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor