Healthcare Provider Details

I. General information

NPI: 1558800607
Provider Name (Legal Business Name): BOREALIS CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35249 KENAI SPUR HWY STE C
SOLDOTNA AK
99669-7673
US

IV. Provider business mailing address

35249 KENAI SPUR HWY STE C
SOLDOTNA AK
99669-7673
US

V. Phone/Fax

Practice location:
  • Phone: 907-420-0836
  • Fax: 907-420-0837
Mailing address:
  • Phone: 907-420-0836
  • Fax: 907-420-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number105714
License Number StateAK

VIII. Authorized Official

Name: DR. LAURA L HULING
Title or Position: OWNER/CEO
Credential: D.C.
Phone: 907-420-7790