Individual
RANDY OBERT LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
410 N RIVER ST, SPOONER, WI 54801-1495
(715) 635-9307
Mailing address
410 N RIVER ST, SPOONER, WI 54801-1495
(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
RAILROAD MEDICARE
WI
05
—
38752600
—
WI
Enumeration date
10/12/2007
Last updated
04/30/2015
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