Provider Demographics
NPI:1285642975
Name:LARSON, JOHN W (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:LARSON
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:18140 ANE STREET NW
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330
Mailing Address - Country:US
Mailing Address - Phone:763-241-5436
Mailing Address - Fax:763-241-5466
Practice Address - Street 1:1740 WEIR DR
Practice Address - Street 2:SUITE 24
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2282
Practice Address - Country:US
Practice Address - Phone:651-232-6830
Practice Address - Fax:651-702-2636
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-04-13
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Provider Licenses
StateLicense IDTaxonomies
MN3500111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN132MOHEOtherBLUE CROSS BLUE SHIELD
MNC03743Medicare ID - Type Unspecified