NPIMap

Organization Active NPI

Larson Chiropractic, LLC

  • Sports Physician Chiropractor
  • Wasilla, AK
National Provider Identifier
1801176672
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
435 Issued in AK
Legal business name
LARSON CHIROPRACTIC, LLC
Practice address
1001 E Bogard Rd
Wasilla, AK 99654-7114
Phone
(907) 376-2225
Fax
(907) 376-9225
NPI assigned
Aug 24, 2011
Last updated
Dec 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SPINE AND SPORTS INJURY CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Authorized official

Name
Dr. Kristofer D Larson, D.C.NPI 1417029976
Title
Organizer
Phone
(907) 376-2225

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 435 AK
Sports Physician Chiropractor 111NS0005X 435 AK Primary

Addresses

Primary practice location

1001 E Bogard Rd
Wasilla, AK 99654-7114

Mailing address

1001 E Bogard Rd
Wasilla, AK 99654-7114
Phone (907) 376-2225

Other names 1

  • Larson Chiropractic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111201000040 AK Part B Supplier - Clinic/Group Practice 7810161858 Receives reassigned benefits from 3 practitioners
Practice locations: Wasilla, AK

National Provider Directory

National Provider Directory
Part of
Spine and Sports Injury

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1001 E Bogard Rd
Wasilla, AK 99654
Phone (907) 373-7246

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1801176672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E BOGARD RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547114",
            "telephone_number": "907-376-2225",
            "fax_number": "907-376-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E BOGARD RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547114",
            "telephone_number": "907-376-2225",
            "fax_number": "907-376-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSON CHIROPRACTIC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPINE AND SPORTS INJURY CENTER, LLC",
        "enumeration_date": "2011-08-24",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KRISTOFER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "907-376-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AK",
            "license": "435",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "AK",
            "license": "435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Larson Chiropractic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.