Provider Demographics
NPI:1225272594
Name:ALTAIR CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ALTAIR CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-357-1818
Mailing Address - Street 1:3161 E PALMER WASILLA HWY
Mailing Address - Street 2:SUITE1
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7271
Mailing Address - Country:US
Mailing Address - Phone:907-357-1818
Mailing Address - Fax:907-357-1814
Practice Address - Street 1:3161 E PALMER WASILLA HWY
Practice Address - Street 2:SUITE1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7271
Practice Address - Country:US
Practice Address - Phone:907-357-1818
Practice Address - Fax:907-357-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1633093Medicaid
AK1636141Medicaid