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General NPI Number Information
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NPI Number | 1417248717
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Entity Type | Organization
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Legal Business Name | SOLDOTNA CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 102 E REDOUBT AVE
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City | SOLDOTNA
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State | AK
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Zip | 99669-8012
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Country | US
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Telephone | 907-262-9117
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Fax | 907-260-3358
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Provider Business Mailing Address
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Address Line | 102 E REDOUBT AVE
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City | SOLDOTNA
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State | AK
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Zip | 99669-8012
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Country | US
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Telephone | 907-262-9117
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Fax | 907-260-3358
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ANTHONY L ENDSLEY
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Credential | DC
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Telephone | 907-262-9117
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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 | 345
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License Number State | AK
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