Healthcare Provider Details

I. General information

NPI: 1588812580
Provider Name (Legal Business Name): DIMOND CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W DIMOND BLVD STE #121
ANCHORAGE AK
99515-1515
US

IV. Provider business mailing address

750 W DIMOND BLVD STE #121
ANCHORAGE AK
99515-1515
US

V. Phone/Fax

Practice location:
  • Phone: 907-344-0033
  • Fax: 907-344-6332
Mailing address:
  • Phone: 907-344-0033
  • Fax: 907-344-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number105677
License Number StateAK

VIII. Authorized Official

Name: JAMES CHAVIS
Title or Position: OWNER
Credential: DC
Phone: 907-790-3371