Provider Demographics
NPI:1750387551
Name:LARSON, CHRIS (DC)
Entity type:Individual
Prefix:
First Name:CHRIS
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 1:20843 GRANADA AVENUE CT N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8151
Mailing Address - Country:US
Mailing Address - Phone:651-270-8427
Mailing Address - Fax:763-595-0291
Practice Address - Street 1:2220 COUNTY HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:763-398-7770
Practice Address - Fax:763-398-7771
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3816111N00000X
CO4819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor