Individual
DANIEL W LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDN
Contact information
Practice address
444 W JACKSON BLVD, CHICAGO, IL 60606-6923
(312) 627-0444
(312) 648-0155
Mailing address
619 W JACKSON BLVD, CHICAGO, IL 60661-5606
(312) 648-4666
(312) 648-0155
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164007258
IL
Other
Enumeration date
07/30/2018
Last updated
09/12/2018
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