Provider Demographics
NPI:1518349604
Name:KEYSTONE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KEYSTONE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAPONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-646-2222
Mailing Address - Street 1:2217 E TUDOR RD
Mailing Address - Street 2:STE. 16
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1068
Mailing Address - Country:US
Mailing Address - Phone:907-646-2222
Mailing Address - Fax:907-646-2201
Practice Address - Street 1:2217 E TUDOR RD
Practice Address - Street 2:STE. 16
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1068
Practice Address - Country:US
Practice Address - Phone:907-646-2222
Practice Address - Fax:907-646-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty