Provider Demographics
NPI:1194056861
Name:JUREN, LARISSA MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:MICHELLE
Last Name:JUREN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HORSE LAKE RD
Mailing Address - Street 2:PO BOX 1720
Mailing Address - City:100 MILE HOUSE
Mailing Address - State:BC
Mailing Address - Zip Code:V0K 2E0
Mailing Address - Country:CA
Mailing Address - Phone:250-395-3000
Mailing Address - Fax:250-395-3055
Practice Address - Street 1:190 HORSE LAKE RD
Practice Address - Street 2:
Practice Address - City:100 MILE HOUSE
Practice Address - State:BC
Practice Address - Zip Code:V0K 2E0
Practice Address - Country:CA
Practice Address - Phone:250-395-3000
Practice Address - Fax:250-395-3055
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor