Healthcare Provider Details

I. General information

NPI: 1730104209
Provider Name (Legal Business Name): RYAN KARL LARSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MAIN ST
SPANISH FORK UT
84660-1726
US

IV. Provider business mailing address

205 N MAIN ST
SPANISH FORK UT
84660-1726
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-2515
  • Fax: 801-798-2510
Mailing address:
  • Phone: 480-293-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14210503-1202
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number14210503-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: