Provider Demographics
NPI:1487796991
Name:DANSER, LARRY W (DC)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:DANSER
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 1:11129 W MICHIGAN AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1061
Mailing Address - Country:US
Mailing Address - Phone:623-972-6575
Mailing Address - Fax:
Practice Address - Street 1:11129 W MICHIGAN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1061
Practice Address - Country:US
Practice Address - Phone:623-972-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor