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NPI Code Detail

MEDICARE: STEVEN WAYNE LARSON D.C.

MEDICARE:   STEVEN WAYNE 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
1111N00000XChiropractor4485MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1387R8SHOTHERMNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1922189158
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN WAYNE LARSON D.C.
Provider Business Mailing Address
First Line : PO BOX 557
Second Line :
City : SHERBURN
State : MN
Zip : 56171-0557
Country : US
Telephone Number : 507-764-4080
Fax Number : 507-764-4081
Provider Business Practice Location Address
First Line : 27 MAIN ST
Second Line :
City : SHERBURN
State : MN
Zip : 56171
Country : US
Telephone Number : 507-764-4080
Fax Number : 507-764-4081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 10/08/2007

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Directions to “ STEVEN WAYNE LARSON D.C.” Practice Location

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