Provider Demographics
NPI:1770757809
Name:ACCIDENT & INJURY CENTER OF ALASKA, INC
Entity type:Organization
Organization Name:ACCIDENT & INJURY CENTER OF ALASKA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-868-7821
Mailing Address - Street 1:218 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3977
Mailing Address - Country:US
Mailing Address - Phone:907-868-7821
Mailing Address - Fax:907-868-7584
Practice Address - Street 1:218 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3977
Practice Address - Country:US
Practice Address - Phone:907-868-7821
Practice Address - Fax:907-868-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK902924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK161801Medicare PIN