Provider Demographics
NPI:1659864809
Name:ARCTIC CHIROPRACTIC SOUTH LLC
Entity Type:Organization
Organization Name:ARCTIC CHIROPRACTIC SOUTH LLC
Other - Org Name:ARCTIC CHIROPRACTIC EAST ANCHORAGE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-243-0660
Mailing Address - Street 1:1389 HUFFMAN PARK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3534
Mailing Address - Country:US
Mailing Address - Phone:907-222-6122
Mailing Address - Fax:907-205-5740
Practice Address - Street 1:7731 E NORTHERN LIGHTS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3572
Practice Address - Country:US
Practice Address - Phone:907-280-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty