Provider Demographics
NPI:1366585861
Name:PRENTICE, DAVID Y (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:Y
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 LAKE OTIS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2176
Mailing Address - Country:US
Mailing Address - Phone:907-522-3511
Mailing Address - Fax:907-522-8551
Practice Address - Street 1:6634 LAKE OTIS PKWY STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507
Practice Address - Country:US
Practice Address - Phone:907-522-3511
Practice Address - Fax:907-522-8551
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0418111N00000X
AKCHIC418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK160221Medicare PIN