Provider Demographics
NPI:1770692493
Name:ALASKA CHIROPRACTIC AND THERAPY PC
Entity type:Organization
Organization Name:ALASKA CHIROPRACTIC AND THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LORENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-694-1285
Mailing Address - Street 1:11901 BUSINESS BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7701
Mailing Address - Country:US
Mailing Address - Phone:907-694-1128
Mailing Address - Fax:907-694-1286
Practice Address - Street 1:11901 BUSINESS BLVD STE 108
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7701
Practice Address - Country:US
Practice Address - Phone:907-694-1128
Practice Address - Fax:907-694-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U42290Medicare UPIN