Healthcare Provider Details

I. General information

NPI: 1215983259
Provider Name (Legal Business Name): WHITE SPRUCE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SADLER WAY STE 104
FAIRBANKS AK
99701-3175
US

IV. Provider business mailing address

104 KUTTER RD
FAIRBANKS AK
99701-3169
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-3600
  • Fax: 907-452-3695
Mailing address:
  • Phone: 907-452-3600
  • Fax: 907-452-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT D LUPER
Title or Position: VP
Credential: ND
Phone: 907-452-3600