Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00002535 | WA |
Y | 111N00000X | Chiropractor | CHIR003115 | GA |
NPI | 1003971458 |
---|---|
Provider Name | M. Chad Larsen |
First Address | Leesburg, GA 31763-4868 |
Second Address | Leesburg, GA 31763-4868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/07/2007 |