Provider Demographics
NPI:1700908795
Name:LARSEN, BRIAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:LARSEN
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 1:507 KNIGHT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4258
Mailing Address - Country:US
Mailing Address - Phone:509-943-4919
Mailing Address - Fax:
Practice Address - Street 1:507 KNIGHT ST
Practice Address - Street 2:SUITE B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4258
Practice Address - Country:US
Practice Address - Phone:509-943-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227613OtherLABOR & INDUSTRIES
WA0227613OtherLABOR & INDUSTRIES