Healthcare Provider Details

I. General information

NPI: 1437884384
Provider Name (Legal Business Name): FAIRBANKS ACUPUNCTURE AND HERBAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY AVE STE 3
FAIRBANKS AK
99709-3651
US

IV. Provider business mailing address

600 UNIVERSITY AVE STE 3
FAIRBANKS AK
99709-3651
US

V. Phone/Fax

Practice location:
  • Phone: 907-313-8971
  • Fax: 907-313-1418
Mailing address:
  • Phone: 907-313-8971
  • Fax: 907-313-1418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANNA KAYE TRON
Title or Position: OWNDER
Credential: L.AC.
Phone: 907-313-8971