Provider Demographics
NPI:1316091598
Name:LARSON, LARS ERIC (DC)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:ERIC
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 1:2030 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6108
Mailing Address - Country:US
Mailing Address - Phone:941-954-3700
Mailing Address - Fax:
Practice Address - Street 1:2030 BEE RIDGE RD
Practice Address - Street 2:STE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6108
Practice Address - Country:US
Practice Address - Phone:941-954-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001027111N00000X
FLCH-0007372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTLAVN2563Medicare PIN
FLAH540ZMedicare PIN