Healthcare Provider Details

I. General information

NPI: 1043388838
Provider Name (Legal Business Name): DR DANIEL W LARSON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E BOGARD RD
WASILLA AK
99654-7114
US

IV. Provider business mailing address

1001 E BOGARD RD
WASILLA AK
99654-7114
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-2225
  • Fax: 907-376-9225
Mailing address:
  • Phone: 907-376-2225
  • Fax: 907-376-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL WERNER LARSON
Title or Position: OWNER
Credential: DC CCSP ACRB REGISTR
Phone: 907-376-2225