Provider Demographics
NPI:1407058100
Name:FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-563-4111
Mailing Address - Street 1:PO BOX 220213
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-0213
Mailing Address - Country:US
Mailing Address - Phone:907-563-4111
Mailing Address - Fax:907-563-4113
Practice Address - Street 1:5121 ARCTIC BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7009
Practice Address - Country:US
Practice Address - Phone:907-563-4111
Practice Address - Fax:907-563-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0013Medicaid
AK0000WCJJRMedicare ID - Type Unspecified
AKCH0013Medicaid