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NPI Code Detail

MEDICARE: DR. NELS V LARSEN MS DC RD

MEDICARE: DR. NELS V LARSEN MS DC RD
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
1111N00000XChiropractor7110AZ
2133V00000XRegistered Dietitian

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17139212OTHERAZAETNA
2AZ0156940OTHERAZBC/BS

General Provider Information

NPI Number : 1639127442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NELS V LARSEN MS DC RD
Provider Business Mailing Address
First Line : PO BOX 91
Second Line :
City : LAVEEN
State : AZ
Zip : 85339-0091
Country : US
Telephone Number : 602-237-2555
Fax Number : 480-275-3774
Provider Business Practice Location Address
First Line : 5099 W DOBBINS RD
Second Line : STE B
City : LAVEEN
State : AZ
Zip : 85339-9733
Country : US
Telephone Number : 602-237-2555
Fax Number : 480-275-3774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 07/09/2014

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