Provider Demographics
NPI:1760518492
Name:ABBOTT, RICK E (DC)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:E
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-561-2330
Mailing Address - Fax:907-561-1282
Practice Address - Street 1:3330 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-561-2330
Practice Address - Fax:907-561-1282
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK25989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0000QGDTZMedicare ID - Type Unspecified
T66979Medicare UPIN