Provider Demographics
NPI:1639368780
Name:GARDEN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GARDEN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-373-5054
Mailing Address - Street 1:1830 E PARKS HWY
Mailing Address - Street 2:SUITE A120
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7353
Mailing Address - Country:US
Mailing Address - Phone:907-373-5054
Mailing Address - Fax:907-373-5058
Practice Address - Street 1:1830 E PARKS HWY
Practice Address - Street 2:SUITE A120
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7353
Practice Address - Country:US
Practice Address - Phone:907-373-5054
Practice Address - Fax:907-373-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH22422Medicaid
AKK152620Medicare PIN