Provider Demographics
NPI:1295743284
Name:LARSON, TERESA LYNN (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:LARSON
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PINE LAKE RD
Mailing Address - Street 2:STE #2
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3692
Mailing Address - Country:US
Mailing Address - Phone:402-421-8284
Mailing Address - Fax:402-421-8220
Practice Address - Street 1:1501 PINE LAKE RD
Practice Address - Street 2:STE #2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3692
Practice Address - Country:US
Practice Address - Phone:402-421-8284
Practice Address - Fax:402-421-8220
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09740OtherBCBS
NE278050Medicare ID - Type Unspecified
NE09740OtherBCBS