Provider Demographics
NPI:1083767826
Name:CREIGHTON, LAURA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8963
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-8963
Mailing Address - Country:US
Mailing Address - Phone:907-487-9798
Mailing Address - Fax:907-487-9790
Practice Address - Street 1:814 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6599
Practice Address - Country:US
Practice Address - Phone:907-487-9798
Practice Address - Fax:907-487-9790
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK 160951Medicare PIN
AKU99330Medicare UPIN