MEDICARE: DR. RACHELLE A. LARSEN 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	3074	SC

General Provider Information

NPI Number	:	1942226451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHELLE A. LARSEN D.C.

Provider Business Mailing Address
First Line	:	5401 NETHERBY LANE
Second Line	:	SUITE 201
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7363
Country	:	US
Telephone Number	:	843-225-5362
Fax Number	:	843-225-5363

Provider Business Practice Location Address
First Line	:	5401 NETHERBY LANE
Second Line	:	SUITE 201
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7363
Country	:	US
Telephone Number	:	843-225-5362
Fax Number	:	843-225-5363

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/18/2007

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