Provider Demographics
NPI:1205063443
Name:LARIMER, JESSE (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:LARIMER
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 1:2100C SE 164TH AVE
Mailing Address - Street 2:#102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4653
Mailing Address - Country:US
Mailing Address - Phone:360-334-5051
Mailing Address - Fax:360-553-4105
Practice Address - Street 1:2100C SE 164TH AVE
Practice Address - Street 2:#102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4653
Practice Address - Country:US
Practice Address - Phone:360-334-5051
Practice Address - Fax:360-553-4105
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60090162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor