Healthcare Provider Details

I. General information

NPI: 1295148229
Provider Name (Legal Business Name): SUMMIT CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 AIRPORT WAY
FAIRBANKS AK
99701
US

IV. Provider business mailing address

1929 AIRPORT WAY
FAIRBANKS AK
99701
US

V. Phone/Fax

Practice location:
  • Phone: 907-479-0036
  • Fax: 907-474-0648
Mailing address:
  • Phone: 907-479-0036
  • Fax: 907-474-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RYAN STURGILL
Title or Position: OWNER
Credential: DC
Phone: 907-479-0036