Provider Demographics
NPI:1053507137
Name:CITY CENTER CHIROPRACTIC
Entity Type:Organization
Organization Name:CITY CENTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRGER
Authorized Official - Middle Name:I
Authorized Official - Last Name:BAASTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-463-5255
Mailing Address - Street 1:800 GLACIER AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1845
Mailing Address - Country:US
Mailing Address - Phone:907-463-5255
Mailing Address - Fax:907-463-5090
Practice Address - Street 1:800 GLACIER AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1845
Practice Address - Country:US
Practice Address - Phone:907-463-5255
Practice Address - Fax:907-463-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152494Medicare UPIN