Provider Demographics
NPI:1710996897
Name:LARSON, LAURA N (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:N
Last Name:LARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-1468
Mailing Address - Country:US
Mailing Address - Phone:970-300-1987
Mailing Address - Fax:719-631-2521
Practice Address - Street 1:51 EAGLE RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:970-300-1987
Practice Address - Fax:719-631-2521
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9994111N00000X
CO3879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611916Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXV06103Medicare UPIN