Provider Demographics
NPI:1922189158
Name:LARSON, STEVEN WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:LARSON
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:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:SHERBURN
Mailing Address - State:MN
Mailing Address - Zip Code:56171-0557
Mailing Address - Country:US
Mailing Address - Phone:507-764-4080
Mailing Address - Fax:507-764-4081
Practice Address - Street 1:27 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERBURN
Practice Address - State:MN
Practice Address - Zip Code:56171
Practice Address - Country:US
Practice Address - Phone:507-764-4080
Practice Address - Fax:507-764-4081
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN387R8SHOtherBLUE CROSS BLUE SHIELD
MNC03432Medicare PIN