Provider Demographics
NPI:1912364704
Name:ARCTIC CHIROPRACTIC NOME, LLC
Entity Type:Organization
Organization Name:ARCTIC CHIROPRACTIC NOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-250-7246
Mailing Address - Street 1:113 W FRONT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-9800
Mailing Address - Country:US
Mailing Address - Phone:907-443-7477
Mailing Address - Fax:907-443-7487
Practice Address - Street 1:113 W FRONT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-9800
Practice Address - Country:US
Practice Address - Phone:907-443-7477
Practice Address - Fax:907-443-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty