Provider Demographics
NPI:1912462888
Name:ODNEY-PACHECO, ANTHONY SEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SEAN
Last Name:ODNEY-PACHECO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S SEWARD MERIDIAN PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8369
Mailing Address - Country:US
Mailing Address - Phone:907-414-2442
Mailing Address - Fax:
Practice Address - Street 1:1301 S SEWARD MERIDIAN PKWY STE G
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8369
Practice Address - Country:US
Practice Address - Phone:907-414-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK142033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK142033OtherSTATE BOARD