Healthcare Provider Details

I. General information

NPI: 1487860912
Provider Name (Legal Business Name): JARED MICHAEL LARSEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HIGHWAY 36 W 400
ROSEVILLE MN
55113-4034
US

IV. Provider business mailing address

1700 HIGHWAY 36 W 400
ROSEVILLE MN
55113-4034
US

V. Phone/Fax

Practice location:
  • Phone: 651-636-0055
  • Fax:
Mailing address:
  • Phone: 651-636-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4893
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberN204
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: