Healthcare Provider Details

I. General information

NPI: 1568598613
Provider Name (Legal Business Name): KURT ALLEN LARSEN D.C,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 PARK AVE
HOT SPRINGS AR
71901-9475
US

IV. Provider business mailing address

4303 PARK AVE
HOT SPRINGS AR
71901-9475
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-9355
  • Fax:
Mailing address:
  • Phone: 501-623-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number1022
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1022
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1022
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number1022
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1022
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1022
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: