Individual
DR. MARK WILLIAM LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
7 N WABASH ST, PERU, IN 46970-2224
(765) 472-1127
(765) 472-5228
Mailing address
7 N WABASH ST, PERU, IN 46970-2224
(765) 472-1127
(765) 472-5228
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001019A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092330
ANTHEM WELLPOINT
IN
Enumeration date
03/20/2007
Last updated
07/08/2007
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