MEDICARE: ALASKA CHIROPRACTIC AND THERAPY PC

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	280	AK

General Provider Information

NPI Number	:	1770692493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA CHIROPRACTIC AND THERAPY PC

Provider Business Mailing Address
First Line	:	11901 BUSINESS BLVD STE 108
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7701
Country	:	US
Telephone Number	:	907-694-1128
Fax Number	:	907-694-1286

Provider Business Practice Location Address
First Line	:	11901 BUSINESS BLVD STE 108
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7701
Country	:	US
Telephone Number	:	907-694-1128
Fax Number	:	907-694-1286

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER E LORENTZEN
Credential	:	DC
Telephone Number	:	907-694-1285

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/04/2017

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