Provider Demographics
NPI:1619246964
Name:NORTHSTAR CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTHSTAR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDVIK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-357-4111
Mailing Address - Street 1:1700 E BOGARD RD
Mailing Address - Street 2:BUILDING B, SUITE 200
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6563
Mailing Address - Country:US
Mailing Address - Phone:907-357-4111
Mailing Address - Fax:907-357-4199
Practice Address - Street 1:1700 E BOGARD RD
Practice Address - Street 2:BUILDING B, SUITE 200
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6563
Practice Address - Country:US
Practice Address - Phone:907-357-4111
Practice Address - Fax:907-357-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty