Provider Demographics
NPI:1679750764
Name:METRO CHIROPRACTIC
Entity Type:Organization
Organization Name:METRO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALDROUP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-276-6325
Mailing Address - Street 1:401 W INTERNATIONAL AIRPORT RD STE 11
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1168
Mailing Address - Country:US
Mailing Address - Phone:907-276-6325
Mailing Address - Fax:907-276-6330
Practice Address - Street 1:401 W INTERNATIONAL AIRPORT RD STE 11
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1168
Practice Address - Country:US
Practice Address - Phone:907-276-6325
Practice Address - Fax:907-276-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK192093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0057Medicaid
AKCH0057Medicaid
AKK152687Medicare PIN