Provider Demographics
NPI:1093515264
Name:THE PREMIER LIFE OF ANCHORAGE
Entity type:Organization
Organization Name:THE PREMIER LIFE OF ANCHORAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:REAGAN
Authorized Official - Last Name:DEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-679-4864
Mailing Address - Street 1:3317 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4840
Mailing Address - Country:US
Mailing Address - Phone:559-679-4864
Mailing Address - Fax:
Practice Address - Street 1:751 E 36TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4166
Practice Address - Country:US
Practice Address - Phone:559-679-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty