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General NPI Number Information
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NPI Number | 1194917898
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Entity Type | Individual
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Provider Name | STANLEY GLENN LARSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/18/2015
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Provider Practice Location Address
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Address Line | 3898 W. 13400 SO. SUITE B.
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City | RIVERTON
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State | UT
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Zip | 84065-6038
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Country | US
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Telephone | 801-302-0660
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Fax | 801-302-2239
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Provider Business Mailing Address
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Address Line | 1566 E SEGO LILY DR
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City | SANDY
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State | UT
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Zip | 84092-4330
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Country | US
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Telephone | 307-277-2354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5052470-1202
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License Number State | UT
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