Provider Demographics
NPI:1275156093
Name:SITKACHIRO LLC
Entity Type:Organization
Organization Name:SITKACHIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-543-9367
Mailing Address - Street 1:1807 SAWMILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9768
Mailing Address - Country:US
Mailing Address - Phone:801-543-9367
Mailing Address - Fax:
Practice Address - Street 1:310 ERLER ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7336
Practice Address - Country:US
Practice Address - Phone:907-747-8502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2102625OtherSTATE OF ALASKA