=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841679735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHALBERG ACUPUNCTURE AND HERBAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2015
-----------------------------------------------------
Last Update Date | 05/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 UNIVERSITY AVE SUITE 1
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99709-3688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-298-2417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 UNIVERSITY AVE SUITE 1
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99709-3688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-298-2417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHLEEN ANNE SCHALBERG
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 585-298-2417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 145
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------