Provider Demographics
NPI:1003218215
Name:KENAI SPORTS & FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:KENAI SPORTS & FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-283-3752
Mailing Address - Street 1:130 S WILLOW ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-9107
Mailing Address - Country:US
Mailing Address - Phone:907-283-3752
Mailing Address - Fax:907-283-3792
Practice Address - Street 1:130 S WILLOW ST
Practice Address - Street 2:SUITE #7
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9107
Practice Address - Country:US
Practice Address - Phone:907-283-3752
Practice Address - Fax:907-283-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK165627Medicare PIN