Provider Demographics
NPI:1952423477
Name:LARSON, CLINTON CHAD (NMD, DC)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:CHAD
Last Name:LARSON
Suffix:
Gender:M
Credentials:NMD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S HIGHWAY 101 STE 109
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1844
Mailing Address - Country:US
Mailing Address - Phone:858-209-2400
Mailing Address - Fax:
Practice Address - Street 1:215 S HIGHWAY 101 STE 109
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1844
Practice Address - Country:US
Practice Address - Phone:858-209-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND619175F00000X
CADC26086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath