Healthcare Provider Details

I. General information

NPI: 1134684541
Provider Name (Legal Business Name): ARCTIC CHIROPRACTIC EAST ANCHORAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 E NORTHERN LIGHTS BLVD STE 220
ANCHORAGE AK
99504-3572
US

IV. Provider business mailing address

4000 W DIMOND BLVD UNIT 4
ANCHORAGE AK
99502-1474
US

V. Phone/Fax

Practice location:
  • Phone: 907-280-9991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALIA DAVIS
Title or Position: BILLING
Credential:
Phone: 800-716-3537