Provider Demographics
NPI:1205921277
Name:LARSON, CHAD (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
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 1:5214 N WESTERN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2589
Mailing Address - Country:US
Mailing Address - Phone:773-784-1000
Mailing Address - Fax:773-784-1398
Practice Address - Street 1:5214 N WESTERN AVE
Practice Address - Street 2:STE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2589
Practice Address - Country:US
Practice Address - Phone:773-784-1000
Practice Address - Fax:773-784-1398
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38007103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor