MEDICARE: DR. NANCY G LARSON D.C.

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	DC14964	CA

General Provider Information

NPI Number	:	1295739860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY G LARSON D.C.

Provider Business Mailing Address
First Line	:	69115 RAMON RD
Second Line	:	# F1
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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