Provider Demographics
NPI:1700474673
Name:LARSON, KODI (DC)
Entity type:Individual
Prefix:DR
First Name:KODI
Middle Name:
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 1:3700 S KIWANIS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4294
Mailing Address - Country:US
Mailing Address - Phone:605-274-7007
Mailing Address - Fax:
Practice Address - Street 1:3700 S KIWANIS AVE STE 3
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4294
Practice Address - Country:US
Practice Address - Phone:605-274-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor