MEDICARE: ALASKA SPINE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	417904	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093710717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA SPINE CENTER, LLC

Provider Business Mailing Address
First Line	:	4100 LAKE OTIS PKWY
Second Line	:	SUITE 212
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5230
Country	:	US
Telephone Number	:	907-644-5500
Fax Number	:	907-644-5555

Provider Business Practice Location Address
First Line	:	4100 LAKE OTIS PKWY
Second Line	:	SUITE 212
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5230
Country	:	US
Telephone Number	:	907-644-5500
Fax Number	:	907-644-5555

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEON H CHANDLER
Credential	:	M.D.
Telephone Number	:	907-644-5500

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	01/15/2008

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Directions to “ALASKA SPINE CENTER, LLC ” Practice Location

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