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Organization
LARSON CHIROPRACTIC OFFICE INC
Active
Organization
LARSON CHIROPRACTIC OFFICE INC
Active
Other names
Randy O Larson DC
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY OBERT LARSON DC (PRESIDENT)
(715) 635-9307
Entity
Organization
Contact information
Practice address
410 N RIVER ST, SPOONER, WI 54801
(715) 635-9307
Mailing address
410 N RIVER ST, SPOONER, WI 54801
(715) 635-9307
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1432012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350052432
RR MEDICARE
—
05
—
38752600
—
WI
Enumeration date
12/05/2006
Last updated
04/20/2015
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