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General NPI Number Information
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NPI Number | 1023463577
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Entity Type | Organization
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Legal Business Name | ARCTIC CHIROPRACTIC AND PHYSICAL MEDICINE KETCHIKAN
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 2050 SEA LEVEL DR SUITE 106
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City | KETCHIKAN
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State | AK
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Zip | 99901-6058
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Country | US
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Telephone | 907-790-3371
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Fax | 907-790-2102
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Provider Business Mailing Address
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Address Line | 2243 JORDAN AVE
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City | JUNEAU
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State | AK
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Zip | 99801-8050
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Country | US
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Telephone | 907-790-3371
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Fax | 907-790-2102
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Authorized Official
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Title or Position | OWNER
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Name | JAMES CHAVIS
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Credential | D.C.
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Telephone | 907-888-9032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 104600
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 468
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License Number State | AK
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