Provider Demographics
NPI:1801051131
Name:LARSEN, LEE M (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
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 1:419 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048
Mailing Address - Country:US
Mailing Address - Phone:402-296-3130
Mailing Address - Fax:402-296-3485
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-1961
Practice Address - Country:US
Practice Address - Phone:402-296-3130
Practice Address - Fax:402-296-3485
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE261117Medicare PIN