Basic Information
| Provider Information | |||||||||
| NPI: | 1285019869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRBANKS FAMILY WELLNESS,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 AIRPORT WAY #4 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074792331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3550 AIRPORT WAY STE 4 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074792306 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2015 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | FALCONER | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9074792331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 596 | AK | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 171100000X | 152 | AK | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist | 175F00000X | 40 | AK | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Naturopath |
No ID Information.