Healthcare Provider Details

I. General information

NPI: 1467600510
Provider Name (Legal Business Name): LARSON CHIROPRACTIC & ACUPUNCTURE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 OLD CHENEY RD 1A
LINCOLN NE
68516-3107
US

IV. Provider business mailing address

4910 OLD CHENEY RD # 1A
LINCOLN NE
68516-3107
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-1626
  • Fax:
Mailing address:
  • Phone: 402-421-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1204
License Number StateNE

VIII. Authorized Official

Name: CHAD EUGENE LARSON
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 402-421-1621