Provider Demographics
NPI:1083733737
Name:MOUNTAIN VIEW CHIROPRACTIC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:DESHAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-6688
Mailing Address - Street 1:7758 N GOLDCORD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-357-6688
Mailing Address - Fax:907-357-9655
Practice Address - Street 1:5461 E MAYFLOWER #6
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-6688
Practice Address - Fax:907-357-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH03081Medicaid
AKU070753Medicare UPIN
AKCH03081Medicaid