Provider Demographics
NPI:1770696049
Name:LARSON, CHAD EUGENE (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:EUGENE
Last Name:LARSON
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 OLD CHENEY RD
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3107
Mailing Address - Country:US
Mailing Address - Phone:402-421-1626
Mailing Address - Fax:402-421-1671
Practice Address - Street 1:4910 OLD CHENEY RD
Practice Address - Street 2:UNIT 1A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3107
Practice Address - Country:US
Practice Address - Phone:402-421-1626
Practice Address - Fax:402-421-1671
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09728OtherBCBS
NE09728OtherBCBS
U78646Medicare UPIN