Provider Demographics
NPI:1639780596
Name:SPORTS INJURY CHIROPRACTIC
Entity Type:Organization
Organization Name:SPORTS INJURY CHIROPRACTIC
Other - Org Name:SPORTS, PERSONAL INJURY AND CHIROPRACTIC CONSULTING LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-726-3668
Mailing Address - Street 1:125 N WILLOW ST STE B
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7702
Mailing Address - Country:US
Mailing Address - Phone:907-726-3668
Mailing Address - Fax:
Practice Address - Street 1:1700 E BOGARD RD STE A200
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6569
Practice Address - Country:US
Practice Address - Phone:907-726-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty