# SOUTHCENTRAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508386178
- **Authorized official:** RONALD LEE OLSON (VP OF FINANCE)
- **Authorized official phone:** (907) 729-4939

## Contact information

- **Practice address:** 1001 S KNIK GOOSE BAY RD, WASILLA, AK 99654-8083
- **Practice address phone:** (907) 729-8624
- **Mailing address:** 4501 DIPLOMACY DR, ANCHORAGE, AK 99508-5919
- **Mailing address phone:** (907) 729-4955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 20467 | AK | Yes |

## Other

- **Enumeration date:** 06/23/2017
- **Last updated:** 06/23/2017