NPIMap

Organization Active NPI

Larson Chiropractic Office Inc

  • Chiropractor
  • Spooner, WI
National Provider Identifier
1457419863
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1432012 Issued in WI
Legal business name
LARSON CHIROPRACTIC OFFICE INC
Practice address
410 N River St
Spooner, WI 54801
Phone
(715) 635-9307
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randy Obert Larson, DCNPI 1437347648
Title
President
Phone
(715) 635-9307

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 1432012 WI Primary

Addresses

Primary practice location

410 N River St
Spooner, WI 54801

Mailing address

410 N River St
Spooner, WI 54801
Phone (715) 635-9307

Other identifiers 2

IdentifierTypeStateIssuer
350052432OtherRR MEDICARE
38752600MedicaidWI

Other names 1

  • Randy O Larson DC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071204000229 WI Part B Supplier - Clinic/Group Practice 7113016833 Receives reassigned benefits from 1 practitioner
Practice locations: Spooner, WI

National Provider Directory

National Provider Directory

Locations

410 N River St
Spooner, WI 54801
Phone (715) 635-4858

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429488000000",
    "number": "1457419863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N RIVER ST",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "54801",
            "telephone_number": "715-635-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N RIVER ST",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "54801",
            "telephone_number": "715-635-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSON CHIROPRACTIC OFFICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2015-04-20",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "OBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-635-9307",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "1432012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "350052432",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38752600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randy O Larson DC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Spooner, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.