MEDICARE: ALASKA SPINE & PAIN CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	111NN0400X	Neurology Chiropractor
3	261QP2000X	Physical Therapy Clinic/Center
4	261QM1300X	Multi-Specialty Clinic/Center

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	:	1659869089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA SPINE & PAIN CENTER, LLC

Provider Business Mailing Address
First Line	:	500 E BENSON BLVD STE 103
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-4148
Country	:	US
Telephone Number	:	907-561-4474
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 OLD SEWARD HWY STE 11
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503
Country	:	US
Telephone Number	:	907-770-9225
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ DOCTOR
Name	:	CALEB JEREMIAH CRAIG
Credential	:	DC
Telephone Number	:	907-561-4474

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	11/16/2018

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Directions to “ALASKA SPINE & PAIN CENTER, LLC ” Practice Location

Language	Start Address	Practice Location

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