Provider Demographics
NPI:1861584096
Name:LARSON, CARL OSCAR (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:OSCAR
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 1:1489 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2802
Mailing Address - Country:US
Mailing Address - Phone:805-495-8104
Mailing Address - Fax:805-495-6094
Practice Address - Street 1:1489 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2802
Practice Address - Country:US
Practice Address - Phone:805-495-8104
Practice Address - Fax:805-495-6094
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24466Medicare ID - Type UnspecifiedMEDICARE NUMBER