Provider Demographics
NPI:1639598568
Name:ARCTIC PAIN PARTNERS INCORPORATED
Entity Type:Organization
Organization Name:ARCTIC PAIN PARTNERS INCORPORATED
Other - Org Name:ARCTIC MEDICINE AND PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-713-4721
Mailing Address - Street 1:5701 LAKE OTIS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1778
Mailing Address - Country:US
Mailing Address - Phone:206-713-4721
Mailing Address - Fax:
Practice Address - Street 1:2004 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2704
Practice Address - Country:US
Practice Address - Phone:206-713-4721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1305208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty