Provider Demographics
NPI:1356060990
Name:NORTH STAR CHIROPRACTIC WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:NORTH STAR CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANIFEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-337-7463
Mailing Address - Street 1:PO BOX 111224
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-1224
Mailing Address - Country:US
Mailing Address - Phone:907-337-7463
Mailing Address - Fax:907-337-7400
Practice Address - Street 1:1120 HUFFMAN RD STE 23
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3561
Practice Address - Country:US
Practice Address - Phone:907-337-7463
Practice Address - Fax:907-337-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty