Provider Demographics
NPI:1295739860
Name:LARSON, NANCY G (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:G
Last Name:LARSON
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 1:69115 RAMON RD
Mailing Address - Street 2:# F1
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05576Medicare UPIN
CADC0149640Medicare ID - Type Unspecified