Provider Demographics
NPI:1871904771
Name:HEALTHWISE BACK, NECK, AND EXTREMITY CARE CENTER, PC
Entity type:Organization
Organization Name:HEALTHWISE BACK, NECK, AND EXTREMITY CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-694-2273
Mailing Address - Street 1:11421 OLD GLENN HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7729
Mailing Address - Country:US
Mailing Address - Phone:907-694-2273
Mailing Address - Fax:
Practice Address - Street 1:11421 OLD GLENN HWY
Practice Address - Street 2:STE 101
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7729
Practice Address - Country:US
Practice Address - Phone:907-694-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK315111N00000X
AK587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty