=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861686255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENINSULA HEALTH CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 10/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33870 POLAR ST
-----------------------------------------------------
City | SOLDOTNA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99669-9251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-260-4844
-----------------------------------------------------
Fax | 907-262-9935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33870 POLAR ST
-----------------------------------------------------
City | SOLDOTNA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99669-9251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-260-4844
-----------------------------------------------------
Fax | 907-262-9935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EVAN EUGENE FRISK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 907-260-4844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------