Provider Demographics
NPI:1942226451
Name:LARSEN, RACHELLE A (DC)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:A
Last Name:LARSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 NETHERBY LANE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7363
Mailing Address - Country:US
Mailing Address - Phone:843-225-5362
Mailing Address - Fax:843-225-5363
Practice Address - Street 1:5401 NETHERBY LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7363
Practice Address - Country:US
Practice Address - Phone:843-225-5362
Practice Address - Fax:843-225-5363
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA15138553Medicare PIN
SCV10053Medicare UPIN