NPIMap

Organization Active NPI

Sports & Spinal Injury Clinic, LLC

  • Chiropractor
  • Anchorage, AK
National Provider Identifier
1174719199
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
SPORTS & SPINAL INJURY CLINIC, LLC
Practice address
6634 Lake Otis Pkwy
A
Anchorage, AK 99507-2176
Phone
(907) 522-3511
Fax
(907) 522-8551
NPI assigned
Sep 24, 2007
Last updated
Sep 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew K Huettl, D.C.NPI 1285722025
Title
Chiropractor
Phone
(907) 522-3511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

6634 Lake Otis Pkwy
A
Anchorage, AK 99507-2176

Mailing address

6634 Lake Otis Pkwy
A
Anchorage, AK 99507-2176
Phone (907) 522-3511

Other identifiers 1

IdentifierTypeStateIssuer
CH0328MedicaidAK

National Provider Directory

National Provider Directory
Tax ID family
Matthew K Huettl DC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6634 Lake Otis Pkwy
Anchorage, AK 99507
Phone (907) 230-0632

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1174719199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6634 LAKE OTIS PKWY",
            "address_2": "A",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995072176",
            "telephone_number": "907-522-3511",
            "fax_number": "907-522-8551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6634 LAKE OTIS PKWY",
            "address_2": "A",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995072176",
            "telephone_number": "907-522-3511",
            "fax_number": "907-522-8551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS & SPINAL INJURY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "HUETTL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "907-522-3511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH0328",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.