Provider Demographics
NPI:1235910514
Name:MAT-SU CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MAT-SU CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MIKAYLAH
Authorized Official - Last Name:LUETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-232-4858
Mailing Address - Street 1:PO BOX 870454
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0454
Mailing Address - Country:US
Mailing Address - Phone:907-203-6793
Mailing Address - Fax:
Practice Address - Street 1:10927 W BIG LAKE RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-3300
Practice Address - Country:US
Practice Address - Phone:907-203-6793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty