Provider Demographics
NPI:1043389257
Name:NORTH COUNTRY CHIROPRACTIC AND NATURAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:NORTH COUNTRY CHIROPRACTIC AND NATURAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:907-457-5100
Mailing Address - Street 1:3677 COLLEGE ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709
Mailing Address - Country:US
Mailing Address - Phone:907-457-5100
Mailing Address - Fax:907-457-5102
Practice Address - Street 1:3677 COLLEGE ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709
Practice Address - Country:US
Practice Address - Phone:907-457-5100
Practice Address - Fax:907-457-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK204111N00000X
HI1005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK207615100000OtherBCBS PREMERA OF ALASKA
AKCH2040Medicaid
AKCH2040Medicaid
=========F001OtherBLUE CROSS BLUE SHIELD FE
T75576Medicare UPIN