Provider Demographics
NPI:1598942807
Name:RIDGEVIEW CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RIDGEVIEW CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-458-8633
Mailing Address - Street 1:570 RIVERSTONE WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2940
Mailing Address - Country:US
Mailing Address - Phone:907-458-8633
Mailing Address - Fax:907-458-8622
Practice Address - Street 1:570 RIVERSTONE WAY STE 2
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2940
Practice Address - Country:US
Practice Address - Phone:907-458-8633
Practice Address - Fax:907-458-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK309456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK160273Medicare PIN