Provider Demographics
NPI:1154752301
Name:LARSON, CHANDRA RAE (DC)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:RAE
Last Name:LARSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHANDRA
Other - Middle Name:RAE
Other - Last Name:BURNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12643 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1317
Mailing Address - Country:US
Mailing Address - Phone:913-643-1771
Mailing Address - Fax:913-643-1775
Practice Address - Street 1:12643 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1317
Practice Address - Country:US
Practice Address - Phone:913-643-1771
Practice Address - Fax:913-643-1775
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor