Provider Demographics
NPI:1306029954
Name:FIREWEED CHIROPRACTIC AND MASSAGE
Entity Type:Organization
Organization Name:FIREWEED CHIROPRACTIC AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-790-4053
Mailing Address - Street 1:8800 GLACIER HWY STE 223
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8080
Mailing Address - Country:US
Mailing Address - Phone:907-790-4053
Mailing Address - Fax:907-790-4054
Practice Address - Street 1:8800 GLACIER HWY
Practice Address - Street 2:SUITE 236, JORDAN CREEK CENTER
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8087
Practice Address - Country:US
Practice Address - Phone:907-790-4053
Practice Address - Fax:907-790-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty