Provider Demographics
NPI:1487453429
Name:DEITZ, NATHANAEL REAGAN (DC)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:REAGAN
Last Name:DEITZ
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 1:3317 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4840
Mailing Address - Country:US
Mailing Address - Phone:559-679-4864
Mailing Address - Fax:
Practice Address - Street 1:751 E 36TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4166
Practice Address - Country:US
Practice Address - Phone:559-679-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003424A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor