Provider Demographics
NPI:1295272854
Name:CLINIC OF CHIROPRACTIC HEALTH, LLC
Entity type:Organization
Organization Name:CLINIC OF CHIROPRACTIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:COZADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-7146
Mailing Address - Street 1:141 W PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7525
Mailing Address - Country:US
Mailing Address - Phone:907-235-7146
Mailing Address - Fax:907-235-7186
Practice Address - Street 1:141 W PIONEER AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7525
Practice Address - Country:US
Practice Address - Phone:907-235-7146
Practice Address - Fax:907-235-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHIC137111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000567Medicaid
AKK0000QGCJZMedicare PIN
AKT67029Medicare UPIN