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General NPI Number Information
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NPI Number | 1750387551
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Entity Type | Individual
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Provider Name | CHRIS LARSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2220 COUNTY HIGHWAY 10
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City | MOUNDS VIEW
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State | MN
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Zip | 55112
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Country | US
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Telephone | 763-398-7770
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Fax | 763-398-7771
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Provider Business Mailing Address
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Address Line | 20843 GRANADA AVENUE CT N
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City | FOREST LAKE
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State | MN
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Zip | 55025-8151
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Country | US
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Telephone | 651-270-8427
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Fax | 763-595-0291
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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 | 3816
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4819
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License Number State | CO
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