Provider Demographics
NPI:1528108164
Name:LARISON, AMIE SUZANNE (DC)
Entity type:Individual
Prefix:DR
First Name:AMIE
Middle Name:SUZANNE
Last Name:LARISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMIE
Other - Middle Name:SUZANNE
Other - Last Name:PARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6331 GREEN PINE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9736
Mailing Address - Country:US
Mailing Address - Phone:248-980-7471
Mailing Address - Fax:
Practice Address - Street 1:7743 GRAND RIVER RD STE 106
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7393
Practice Address - Country:US
Practice Address - Phone:248-980-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F355460OtherBLUE CROSS BLUE SHIELD
MIMI3756001Medicare PIN