Provider Demographics
NPI:1033390927
Name:CHUGACH CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:CHUGACH CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:SCHWEIGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-694-9224
Mailing Address - Street 1:PO BOX 770849
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0849
Mailing Address - Country:US
Mailing Address - Phone:907-694-9224
Mailing Address - Fax:
Practice Address - Street 1:11462 BUSINESS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7721
Practice Address - Country:US
Practice Address - Phone:907-694-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH7946Medicaid
AKK160096Medicare PIN
AKT67077Medicare UPIN