Provider Demographics
NPI:1932744836
Name:ALTAIR INTEGRATIVE WELLNESS
Entity Type:Organization
Organization Name:ALTAIR INTEGRATIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WORKMAN DC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-357-1818
Mailing Address - Street 1:3161 E PALMER WASILLA HWY STE 1C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7271
Mailing Address - Country:US
Mailing Address - Phone:907-357-1818
Mailing Address - Fax:907-357-1814
Practice Address - Street 1:3161 E PALMER WASILLA HWY STE 1C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7271
Practice Address - Country:US
Practice Address - Phone:907-357-1818
Practice Address - Fax:907-357-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1633093Medicaid
AK1636141Medicaid