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General NPI Number Information
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NPI Number | 1083048482
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Entity Type | Organization
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Legal Business Name | PHORMATION CHIROPRACTIC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 36304 KENAI SPUR HWY
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-262-9222
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Fax | 907-262-9212
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Provider Business Mailing Address
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Address Line | 36304 KENAI SPUR HWY
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City | SOLDOTNA
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State | AK
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Zip | 99669
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Country | US
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Telephone | 907-262-9222
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Fax | 907-262-9212
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Authorized Official
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Title or Position | CINIC DIRECTOR / OWNER
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Name | MS. CHERA LYNN HEATH
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Credential |
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Telephone | 907-262-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 923462
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License Number State | AK
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