Provider Demographics
NPI:1780787929
Name:LARSON, ROBERT L (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
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 1:2147 OVERLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6478
Mailing Address - Country:US
Mailing Address - Phone:406-655-0101
Mailing Address - Fax:406-655-0032
Practice Address - Street 1:2147 OVERLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6478
Practice Address - Country:US
Practice Address - Phone:406-655-0101
Practice Address - Fax:406-655-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT42281OtherBCBS PROVIDER NUMBER
MT000004571Medicare PIN
MT42281OtherBCBS PROVIDER NUMBER