MEDICARE: DOUGLAS J. LARSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	689	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841265956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS J. LARSON D.C.

Provider Business Mailing Address
First Line	:	1515 5TH AVE
Second Line	:	SUITE 101
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-6031
Country	:	US
Telephone Number	:	605-892-4845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 5TH AVE
Second Line	:	SUITE 101
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-6031
Country	:	US
Telephone Number	:	605-892-4845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/25/2008

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