Provider Demographics
NPI:1801023411
Name:RICK ABBOTT DC PC
Entity Type:Organization
Organization Name:RICK ABBOTT DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-561-2330
Mailing Address - Street 1:3330 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4146
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:99503-4146
Practice Address - Country:US
Practice Address - Phone:907-561-2330
Practice Address - Fax:907-561-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKT66979Medicare UPIN
AKK0000QGDTZMedicare PIN