Provider Demographics
NPI:1841448727
Name:LARSON JUDY, LIBBY KATHLEEN (DC)
Entity type:Individual
Prefix:DR
First Name:LIBBY
Middle Name:KATHLEEN
Last Name:LARSON JUDY
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 1:7204 W 27TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3157
Mailing Address - Country:US
Mailing Address - Phone:612-578-7233
Mailing Address - Fax:
Practice Address - Street 1:10417 EXCELSIOR BLVD
Practice Address - Street 2:STE 3
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-3440
Practice Address - Country:US
Practice Address - Phone:952-922-8895
Practice Address - Fax:952-922-8498
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor