Provider Demographics
NPI:1831584317
Name:LAROUCHE, MARIO (DC, MACOM)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:LAROUCHE
Suffix:
Gender:M
Credentials:DC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELK RUN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-9205
Mailing Address - Country:US
Mailing Address - Phone:970-927-1262
Mailing Address - Fax:
Practice Address - Street 1:100 ELK RUN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9205
Practice Address - Country:US
Practice Address - Phone:970-927-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0003878111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition