Healthcare Provider Details

I. General information

NPI: 1659864809
Provider Name (Legal Business Name): ARCTIC CHIROPRACTIC SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
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

1389 HUFFMAN PARK DR STE 140
ANCHORAGE AK
99515-3534
US

V. Phone/Fax

Practice location:
  • Phone: 907-280-9991
  • Fax:
Mailing address:
  • Phone: 907-222-6122
  • Fax: 907-205-5740

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

VIII. Authorized Official

Name: EDWARD FOSTER
Title or Position: OFFICIAL
Credential:
Phone: 907-243-0660