| Dimond Chiropractic LLC | |
|
750 W Dimond Blvd Ste #121 Anchorage AK 99515-1515 | |
| (907) 344-0033 | |
| (907) 344-6332 |
| Full Name | Dimond Chiropractic LLC |
|---|---|
| Speciality | Chiropractor |
| Location | 750 W Dimond Blvd Ste #121, Anchorage, Alaska |
| Authorized Official Name and Position | James Chavis (OWNER) |
| Authorized Official Contact | 9077903371 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dimond Chiropractic LLC 750 W Dimond Blvd Ste #121 Anchorage AK 99515-1515 Ph: (907) 344-0033 | Dimond Chiropractic LLC 750 W Dimond Blvd Ste #121 Anchorage AK 99515-1515 Ph: (907) 344-0033 |
| NPI Number | 1588812580 |
|---|---|
| Provider Enumeration Date | 09/03/2008 |
| Last Update Date | 08/08/2018 |
| Medicare PECOS PAC ID | 5092060111 |
|---|---|
| Medicare Enrollment ID | O20181005000866 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588812580 | NPI | - | NPPES |
| 1684500 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 105677 (Alaska) | Secondary |
| 111N00000X | Chiropractor | () | Primary |
| 225100000X | Physical Therapist | () | Secondary |
| Provider Name | Joel a Ingersoll |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1831399575 PECOS PAC ID: 9830310440 Enrollment ID: I20141024000298 |
| Provider Name | Jordan Oslan |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1104367515 PECOS PAC ID: 5597099465 Enrollment ID: I20190626002279 |
| Provider Name | Blake Fenton |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1245417773 PECOS PAC ID: 5193803922 Enrollment ID: I20230919003395 |
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