Provider Demographics
NPI:1932965373
Name:MEDICAL ARTS COLLABORATIVE LLC
Entity type:Organization
Organization Name:MEDICAL ARTS COLLABORATIVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:GEORGINA
Authorized Official - Last Name:ALEKSANDRAVICIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-687-5232
Mailing Address - Street 1:PO BOX 82645
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-2645
Mailing Address - Country:US
Mailing Address - Phone:907-687-5232
Mailing Address - Fax:
Practice Address - Street 1:910 OLD STEESE HWY STE B
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3168
Practice Address - Country:US
Practice Address - Phone:907-687-5232
Practice Address - Fax:907-206-7158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty