Provider Demographics
NPI:1144594714
Name:ALYESKA CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ALYESKA CHIROPRACTIC, INC
Other - Org Name:ALYESKA CHIROPRACTIC INC SLOE MBR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-243-0660
Mailing Address - Street 1:4000 W DIMOND BLVD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1474
Mailing Address - Country:US
Mailing Address - Phone:907-243-0660
Mailing Address - Fax:907-248-5481
Practice Address - Street 1:4000 W DIMOND BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1474
Practice Address - Country:US
Practice Address - Phone:907-243-0660
Practice Address - Fax:907-248-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHO242Medicaid
AK0000QGFVPMedicare PIN