Provider Demographics
NPI:1790015261
Name:ARCTIC CHIROPRACTIC DILLINGHAM
Entity Type:Organization
Organization Name:ARCTIC CHIROPRACTIC DILLINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-250-7246
Mailing Address - Street 1:1150 S COLONY WAY
Mailing Address - Street 2:STE 3 PMB 226
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6900
Mailing Address - Country:US
Mailing Address - Phone:907-842-2300
Mailing Address - Fax:
Practice Address - Street 1:222 MAIN ST
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty