Provider Demographics
NPI:1457547150
Name:ALASKA PAIN AND INJURY CLINIC, INC
Entity Type:Organization
Organization Name:ALASKA PAIN AND INJURY CLINIC, INC
Other - Org Name:ALASKA PAIN AND INJURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TIPIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-677-9215
Mailing Address - Street 1:2008 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4101
Mailing Address - Country:US
Mailing Address - Phone:907-677-9215
Mailing Address - Fax:
Practice Address - Street 1:2008 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4101
Practice Address - Country:US
Practice Address - Phone:907-677-9215
Practice Address - Fax:907-569-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK902212261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center