Provider Demographics
NPI:1134362700
Name:NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-321-4844
Mailing Address - Street 1:69115 RAMON RD, #F-1
Mailing Address - Street 2:PMB 516
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3344
Mailing Address - Country:US
Mailing Address - Phone:760-321-4844
Mailing Address - Fax:760-321-9819
Practice Address - Street 1:34020 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6809
Practice Address - Country:US
Practice Address - Phone:760-321-4844
Practice Address - Fax:760-321-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty