Provider Demographics
NPI:1386962108
Name:LARSEN, BRIAN SCOTT (DC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SCOTT
Last Name:LARSEN
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 1:389 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3722
Mailing Address - Country:US
Mailing Address - Phone:530-885-4447
Mailing Address - Fax:530-885-7586
Practice Address - Street 1:389 NEVADA ST.
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-885-4447
Practice Address - Fax:530-885-7586
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor