Provider Demographics
NPI:1952473415
Name:LARSON, BRIAN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
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 1:189 S BINKLEY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8007
Mailing Address - Country:US
Mailing Address - Phone:907-262-0801
Mailing Address - Fax:907-262-0860
Practice Address - Street 1:189 S BINKLEY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8007
Practice Address - Country:US
Practice Address - Phone:907-262-0801
Practice Address - Fax:907-262-0860
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0070Medicaid
P67047Medicare UPIN
AKCH0070Medicaid