Healthcare Provider Details

I. General information

NPI: 1689920142
Provider Name (Legal Business Name): ALCHEMY ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 KELLUM ST SUITE 201
FAIRBANKS AK
99701-4189
US

IV. Provider business mailing address

4048 LAUREL ST SUITE 104
ANCHORAGE AK
99508-5389
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-0560
  • Fax: 907-562-1617
Mailing address:
  • Phone: 907-562-0560
  • Fax: 907-562-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number741113
License Number StateAK

VIII. Authorized Official

Name: WILLIAM C SUNDBERG
Title or Position: PRESIDENT
Credential: CPO, C. PED.
Phone: 907-562-0560