Provider Demographics
NPI:1649296617
Name:COMMUNITY CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-222-2100
Mailing Address - Street 1:550 EAST TUDOR ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-222-2100
Mailing Address - Fax:907-222-2131
Practice Address - Street 1:550 EAST TUDOR ROAD
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-222-2100
Practice Address - Fax:907-222-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0209Medicaid
AKGR0209Medicaid