Provider Demographics
NPI:1740600527
Name:LARSON FAMILY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:LARSON FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:440-653-5973
Mailing Address - Street 1:1811 BULL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2505
Mailing Address - Country:US
Mailing Address - Phone:803-252-0108
Mailing Address - Fax:803-256-6629
Practice Address - Street 1:1811 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2505
Practice Address - Country:US
Practice Address - Phone:803-252-0108
Practice Address - Fax:803-256-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty