Healthcare Provider Details

I. General information

NPI: 1316091598
Provider Name (Legal Business Name): LARS ERIC LARSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 BEE RIDGE RD STE A
SARASOTA FL
34239-6108
US

IV. Provider business mailing address

2030 BEE RIDGE RD
SARASOTA FL
34239-6108
US

V. Phone/Fax

Practice location:
  • Phone: 941-954-3700
  • Fax:
Mailing address:
  • Phone: 941-954-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006-0001027
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH-0007372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: