Provider Demographics
NPI:1215145263
Name:DISCOVER CHIROPRACTIC INC
Entity type:Organization
Organization Name:DISCOVER CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VICTORINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-455-7770
Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:SUITE 140C
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4007
Mailing Address - Country:US
Mailing Address - Phone:907-455-7770
Mailing Address - Fax:907-451-7770
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:SUITE 140C
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4055
Practice Address - Country:US
Practice Address - Phone:907-455-7770
Practice Address - Fax:907-451-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty