MEDICARE: LAUREL STREET CHIROPRACTIC & SPA, JOINT EFFORT, L.L.C.

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	111NR0400X	Rehabilitation Chiropractor	552	AK

General Provider Information

NPI Number	:	1184965576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL STREET CHIROPRACTIC & SPA, JOINT EFFORT, L.L.C.

Provider Business Mailing Address
First Line	:	4119 LAUREL ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5334
Country	:	US
Telephone Number	:	907-248-2848
Fax Number	:	907-258-6610

Provider Business Practice Location Address
First Line	:	4119 LAUREL ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5334
Country	:	US
Telephone Number	:	907-248-2848
Fax Number	:	907-258-6610

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT J VAN ZWEEDEN
Credential	:	DC
Telephone Number	:	907-248-2848

Provider Enumeration Date	:	03/08/2013
Last Update Date	:	01/23/2024

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