Provider Demographics
NPI:1801051230
Name:LARSON, CAMRRON LYNN (DC)
Entity type:Individual
Prefix:
First Name:CAMRRON
Middle Name:LYNN
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 1:4730 E LONE MOUNTAIN RD
Mailing Address - Street 2:STE 112
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5539
Mailing Address - Country:US
Mailing Address - Phone:480-275-7005
Mailing Address - Fax:480-275-7113
Practice Address - Street 1:1226 E WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-4745
Practice Address - Country:US
Practice Address - Phone:563-340-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor