MEDICARE: NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	14964	CA

General Provider Information

NPI Number	:	1134362700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY G LARSON DC CHIROPRACTIC PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	69115 RAMON RD, #F-1
Second Line	:	PMB 516
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3344
Country	:	US
Telephone Number	:	760-321-4844
Fax Number	:	760-321-9819

Provider Business Practice Location Address
First Line	:	34020 DATE PALM DR
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-6809
Country	:	US
Telephone Number	:	760-321-4844
Fax Number	:	760-321-9819

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. NANCY GAYLE LARSON
Credential	:	D.C.
Telephone Number	:	760-321-4844

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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