Provider Demographics
NPI:1093710717
Name:ALASKA SPINE CENTER, LLC
Entity Type:Organization
Organization Name:ALASKA SPINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-644-5500
Mailing Address - Street 1:4100 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5230
Mailing Address - Country:US
Mailing Address - Phone:907-644-5500
Mailing Address - Fax:907-644-5555
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5230
Practice Address - Country:US
Practice Address - Phone:907-644-5500
Practice Address - Fax:907-644-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK417904261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAS5856Medicaid
AKK151869Medicare PIN