Healthcare Provider Details

I. General information

NPI: 1023463577
Provider Name (Legal Business Name): ARCTIC CHIROPRACTIC AND PHYSICAL MEDICINE KETCHIKAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 SEA LEVEL DR SUITE 106
KETCHIKAN AK
99901-6058
US

IV. Provider business mailing address

2243 JORDAN AVE
JUNEAU AK
99801-8050
US

V. Phone/Fax

Practice location:
  • Phone: 907-790-3371
  • Fax: 907-790-2102
Mailing address:
  • Phone: 907-790-3371
  • Fax: 907-790-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number468
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number104600
License Number StateAK

VIII. Authorized Official

Name: JAMES CHAVIS
Title or Position: OWNER
Credential: D.C.
Phone: 907-888-9032