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General NPI Number Information
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NPI Number | 1588864086
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Entity Type | Organization
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Legal Business Name | FAIRBANKS CHIROPRACTIC CLINIC, INCORPORATED
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1118 2ND AVENUE
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City | FAIRBANKS
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State | AK
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Zip | 99701-4228
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Country | US
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Telephone | 907-456-6213
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Fax | 907-452-5925
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Provider Business Mailing Address
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Address Line | 1118 2ND AVENUE
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City | FAIRBANKS
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State | AK
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Zip | 99701-4228
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Country | US
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Telephone | 907-456-6213
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Fax | 907-452-5925
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. AMANDA CADDEN
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Credential |
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Telephone | 907-456-6213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 443
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License Number State | AK
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