Philip Wall, DC
Individual provider Active NPI Chiropractor · Wasilla, AK
NPI 1366259657 · NPPES record last updated Dec 11, 2024
Key facts
- NPI
- 1366259657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 231597 (AK)
- Practice address
- 1830 E Parks Hwy Ste A135
Wasilla, AK 99654-7378 - Phone
- (907) 373-5054
- NPI assigned
- Dec 11, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Arctic Chiropractic West Mat-Su, LLC
Practice addresses (Care Compare)
1830 E Parks Hwy
Suite A120
Wasilla, AK 99654-7380
Phone (907) 373-5054
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251020001684 | AK | Practitioner - Chiropractic | 1355839689 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 231597 | AK | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arctic Chiropractic West Mat-Su, LLC | Chiropractor | Current |
Accepting new patients |
Locations
1150 S Colony Way
Ste 3
Palmer, AK 99645
1830 E Parks Hwy
Ste A120
Wasilla, AK 99654
Phone (907) 373-5054
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 231597 | AK | Yes |
Addresses
Primary practice location
1830 E Parks Hwy Ste A135
Wasilla, AK 99654-7378
Mailing address
1150 S Colony Way Ste 3-226
Palmer, AK 99645-6967
Other providers in Wasilla, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.