Provider Demographics
NPI:1346360914
Name:ANCHORAGE SPINAL CARE CENTER LLC
Entity Type:Organization
Organization Name:ANCHORAGE SPINAL CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TREKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-333-6525
Mailing Address - Street 1:6711 DEBARR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1803
Mailing Address - Country:US
Mailing Address - Phone:907-333-6525
Mailing Address - Fax:907-333-1916
Practice Address - Street 1:6711 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1803
Practice Address - Country:US
Practice Address - Phone:907-333-6525
Practice Address - Fax:907-333-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0267Medicaid
AKU40934Medicare UPIN
AKCH0267Medicaid