Provider Demographics
NPI:1780904391
Name:LARSON, LAURA JEAN (DC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEAN
Last Name:LARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 4TH AVE
Mailing Address - Street 2:UNIT#2
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1940
Mailing Address - Country:US
Mailing Address - Phone:563-285-4803
Mailing Address - Fax:
Practice Address - Street 1:100 S 4TH AVE
Practice Address - Street 2:UNIT#2
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1940
Practice Address - Country:US
Practice Address - Phone:563-285-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor