MEDICARE: CHRIS 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	3816	MN
2	111N00000X	Chiropractor	4819	CO

General Provider Information

NPI Number	:	1750387551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS LARSON D.C.

Provider Business Mailing Address
First Line	:	20843 GRANADA AVENUE CT N
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8151
Country	:	US
Telephone Number	:	651-270-8427
Fax Number	:	763-595-0291

Provider Business Practice Location Address
First Line	:	2220 COUNTY HIGHWAY 10
Second Line	:
City	:	MOUNDS VIEW
State	:	MN
Zip	:	55112
Country	:	US
Telephone Number	:	763-398-7770
Fax Number	:	763-398-7771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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