1043454705 NPI number — RICHARD LARSON CHIROPRACTIC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043454705 NPI number — RICHARD LARSON CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD LARSON CHIROPRACTIC, LLC
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:
1043454705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 VICKSBURG LN N
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55447-3215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-473-1299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 VICKSBURG LN N
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-473-1299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
763-473-1299

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5059 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com