Healthcare Provider Details

I. General information

NPI: 1952473415
Provider Name (Legal Business Name): BRIAN EDWARD LARSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 S BINKLEY ST SUITE 101
SOLDOTNA AK
99669-8007
US

IV. Provider business mailing address

189 S BINKLEY ST SUITE 101
SOLDOTNA AK
99669-8007
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-0801
  • Fax: 907-262-0860
Mailing address:
  • Phone: 907-262-0801
  • Fax: 907-262-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number396
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: