Provider Demographics
NPI:1194917898
Name:LARSON, STANLEY GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:GLENN
Last Name:LARSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1566 E SEGO LILY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4330
Mailing Address - Country:US
Mailing Address - Phone:307-277-2354
Mailing Address - Fax:
Practice Address - Street 1:3898 W. 13400 SO.
Practice Address - Street 2:SUITE B.
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6038
Practice Address - Country:US
Practice Address - Phone:801-302-0660
Practice Address - Fax:801-302-2239
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5052470-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5052470-1202OtherD.C.