Provider Demographics
NPI:1891198875
Name:ARCTIC CHIROPRACTIC & PHYSICAL MEDICINE EAGLE RIVER LLC
Entity type:Organization
Organization Name:ARCTIC CHIROPRACTIC & PHYSICAL MEDICINE EAGLE RIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-694-7700
Mailing Address - Street 1:11431 BUSINESS BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7738
Mailing Address - Country:US
Mailing Address - Phone:907-694-7700
Mailing Address - Fax:
Practice Address - Street 1:11431 BUSINESS BLVD STE 601
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7738
Practice Address - Country:US
Practice Address - Phone:907-694-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty