Provider Demographics
NPI:1497093926
Name:ARCTIC CHIROPRACTIC JUNEAU LLC
Entity Type:Organization
Organization Name:ARCTIC CHIROPRACTIC JUNEAU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-888-9032
Mailing Address - Street 1:2243 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8050
Mailing Address - Country:US
Mailing Address - Phone:907-790-3371
Mailing Address - Fax:907-790-2102
Practice Address - Street 1:2243 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-790-3371
Practice Address - Fax:907-790-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK559111N00000X
AK104600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherMEDICARE IN PROCESS