Provider Demographics
NPI:1295199008
Name:ORTIZ CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ORTIZ CHIROPRACTIC LLC
Other - Org Name:ATLAS DISC & SPINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIZALDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-222-4604
Mailing Address - Street 1:300 E DIMOND BLVD STE 10A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1947
Mailing Address - Country:US
Mailing Address - Phone:907-222-4604
Mailing Address - Fax:
Practice Address - Street 1:300 E DIMOND BLVD STE 10A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1947
Practice Address - Country:US
Practice Address - Phone:907-222-4604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1633241Medicaid