Provider Demographics
NPI:1073658837
Name:PFEIFER, MARY LORENE (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LORENE
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 BARANOF AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5765
Mailing Address - Country:US
Mailing Address - Phone:907-225-9090
Mailing Address - Fax:907-225-9001
Practice Address - Street 1:2901 BARANOF AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5765
Practice Address - Country:US
Practice Address - Phone:907-225-9090
Practice Address - Fax:907-225-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157111N00000X
AK737111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0157Medicaid
AKCH0157Medicaid