Provider Demographics
NPI:1871074773
Name:KETZ CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KETZ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-562-5500
Mailing Address - Street 1:5905 LAKE OTIS PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1700
Mailing Address - Country:US
Mailing Address - Phone:907-562-5500
Mailing Address - Fax:
Practice Address - Street 1:5905 LAKE OTIS PKWY STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1700
Practice Address - Country:US
Practice Address - Phone:907-562-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHIC356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty