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General NPI Number Information
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NPI Number | 1528108164
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Entity Type | Individual
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Provider Name | AMIE SUZANNE LARISON D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 7743 GRAND RIVER RD STE 106
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City | BRIGHTON
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State | MI
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Zip | 48114-7393
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Country | US
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Telephone | 248-980-7471
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Fax |
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Provider Business Mailing Address
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Address Line | 6331 GREEN PINE DR
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City | FENTON
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State | MI
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Zip | 48430-9736
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Country | US
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Telephone | 248-980-7471
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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 | 2301008399
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License Number State | MI
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