1134362700 NPI number — NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION

Table of content: MRS. ANTENIQUE JITAE NEVAREZ LMFT (NPI 1578759098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134362700 NPI number — NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134362700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69115 RAMON RD, #F-1
Provider Second Line Business Mailing Address:
PMB 516
Provider Business Mailing Address City Name:
CATHEDRAL CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92234-3344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-321-4844
Provider Business Mailing Address Fax Number:
760-321-9819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34020 DATE PALM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHEDRAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92234-6809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-321-4844
Provider Business Practice Location Address Fax Number:
760-321-9819
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
GAYLE
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
760-321-4844

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  14964 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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