Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 978 | AL |
NPI | 1356419683 |
---|---|
Provider Name | Robert Arent Larsen |
First Address | Decatur, AL 35603-1510 |
Second Address | Decatur, AL 35603-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |