Individual
DR. JOHN W LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1740 WEIR DR, SUITE 24, WOODBURY, MN 55125-2282
(651) 232-6830
(651) 702-2636
Mailing address
18140 ANE STREET NW, SUITE 303, ELK RIVER, MN 55330
(763) 241-5436
(763) 241-5466
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
3500
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132MOHE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
08/04/2006
Last updated
04/13/2017
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