| NPI | 1255465720 |
|---|---|
| Former Legal Business Name | EAGLE RIVER PAIN & WELLNESS |
| Entity Type | Organization |
| Authorized Contact | JESSICA J SPAYD Registered Agent 907-622-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AK 4245, 677, 20608) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4245, 677, 20608) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AK 4245, 677, 20608) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AK 4245, 677, 20608) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AK 4245, 677, 20608) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AK 4245, 677, 20608) | |
| 208D00000X General Practice (Licence: AK 4245, 677, 20608) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2008-04-20 |