Healthcare Provider Details

I. General information

NPI: 1922338854
Provider Name (Legal Business Name): ALASKA SPINE & PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E BENSON BLVD STE 103
ANCHORAGE AK
99503
US

IV. Provider business mailing address

500 E BENSON BLVD STE 103
ANCHORAGE AK
99503-4148
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-4474
  • Fax:
Mailing address:
  • Phone: 907-561-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CALEB J. CRAIG
Title or Position: OWNER
Credential: D.C.
Phone: 907-561-4474