MEDICARE: VALLEY CHIROPRACTIC CLINIC, INC

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	111N00000X	Chiropractor	AA187	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	:	1104913359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY CHIROPRACTIC CLINIC, INC

Provider Business Mailing Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7018
Country	:	US
Telephone Number	:	907-373-2022
Fax Number	:	907-373-2029

Provider Business Practice Location Address
First Line	:	400 N MAIN ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7018
Country	:	US
Telephone Number	:	907-373-2022
Fax Number	:	907-373-2029

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES MARTIN
Credential	:	D.C., C.C.S.P.
Telephone Number	:	907-373-2022

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	10/22/2010

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