Provider Demographics
NPI:1689853798
Name:LANDIS TREVOR TEW
Entity Type:Organization
Organization Name:LANDIS TREVOR TEW
Other - Org Name:DR. L. TREVOR TEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L. TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-272-2700
Mailing Address - Street 1:1113 W FIREWEED LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1753
Mailing Address - Country:US
Mailing Address - Phone:907-272-2700
Mailing Address - Fax:907-272-2702
Practice Address - Street 1:1113 W FIREWEED LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1753
Practice Address - Country:US
Practice Address - Phone:907-272-2700
Practice Address - Fax:907-272-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK355 AK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK151224Medicare UPIN