1518297084 NPI number — ARCTIC CHIROPRACTIC DELTA

Table of content: (NPI 1518297084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518297084 NPI number — ARCTIC CHIROPRACTIC DELTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCTIC CHIROPRACTIC DELTA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518297084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 S COLONY WAY
Provider Second Line Business Mailing Address:
STE 3 PMB 226
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99645-6900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-895-5055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 ALASKA HWY
Provider Second Line Business Practice Location Address:
JARVIS W STE E1
Provider Business Practice Location Address City Name:
DELTA JUNCTION
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-895-5055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-746-0672

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)