Provider Demographics
NPI:1063746808
Name:LARSON, CHERYL A (LAC, NMD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:LAC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2511
Mailing Address - Country:US
Mailing Address - Phone:678-227-9645
Mailing Address - Fax:
Practice Address - Street 1:332 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1806
Practice Address - Country:US
Practice Address - Phone:678-227-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist