Provider Demographics
NPI:1477961720
Name:ARCTIC PAIN RELIEF CENTER, LLC
Entity type:Organization
Organization Name:ARCTIC PAIN RELIEF CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-250-9441
Mailing Address - Street 1:3901 OLD SEWARD HWY
Mailing Address - Street 2:#11
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6089
Mailing Address - Country:US
Mailing Address - Phone:907-250-9441
Mailing Address - Fax:
Practice Address - Street 1:3901 OLD SEWARD HWY
Practice Address - Street 2:#11
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6089
Practice Address - Country:US
Practice Address - Phone:907-250-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K166120Medicare PIN