Healthcare Provider Details

I. General information

NPI: 1821577032
Provider Name (Legal Business Name): SUNDOG WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 FAIRBANKS ST
ANCHORAGE AK
99503-4145
US

IV. Provider business mailing address

3341 FAIRBANKS ST
ANCHORAGE AK
99503-4145
US

V. Phone/Fax

Practice location:
  • Phone: 907-433-9629
  • Fax:
Mailing address:
  • Phone: 907-339-0330
  • Fax: 907-339-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIC523
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUA126
License Number StateAK

VIII. Authorized Official

Name: JEAN HULBERT
Title or Position: OWNER
Credential: DC, LAC
Phone: 907-339-0330