Provider Demographics
NPI:1417248717
Name:SOLDOTNA CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:SOLDOTNA CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-262-9117
Mailing Address - Street 1:102 E REDOUBT AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8012
Mailing Address - Country:US
Mailing Address - Phone:907-262-9117
Mailing Address - Fax:907-260-3358
Practice Address - Street 1:102 E REDOUBT AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8012
Practice Address - Country:US
Practice Address - Phone:907-262-9117
Practice Address - Fax:907-260-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty