Healthcare Provider Details

I. General information

NPI: 1134851926
Provider Name (Legal Business Name): ARCTIC CHIROPRACTIC REHAB AND PT DUTCH HARBOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RAVEN WAY
DUTCH HARBOR AK
99692-1028
US

IV. Provider business mailing address

PO BOX 921028
DUTCH HARBOR AK
99692-1028
US

V. Phone/Fax

Practice location:
  • Phone: 907-581-4689
  • Fax:
Mailing address:
  • Phone: 907-581-4689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JAMIE STIPPEL
Title or Position: OWNER
Credential:
Phone: 907-581-4689