Provider Demographics
NPI:1447718473
Name:IN MOTION ALASKA
Entity type:Organization
Organization Name:IN MOTION ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-747-8502
Mailing Address - Street 1:310 ERLER ST
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7336
Mailing Address - Country:US
Mailing Address - Phone:907-747-8502
Mailing Address - Fax:907-747-8503
Practice Address - Street 1:310 ERLER ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7336
Practice Address - Country:US
Practice Address - Phone:907-747-8502
Practice Address - Fax:907-747-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK138881OtherSTATE LICENSE NUMBER