Provider Demographics
NPI:1588864086
Name:FAIRBANKS CHIROPRACTIC CLINIC, INCORPORATED
Entity type:Organization
Organization Name:FAIRBANKS CHIROPRACTIC CLINIC, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-456-6213
Mailing Address - Street 1:1118 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4228
Mailing Address - Country:US
Mailing Address - Phone:907-456-6213
Mailing Address - Fax:907-452-5925
Practice Address - Street 1:1118 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4228
Practice Address - Country:US
Practice Address - Phone:907-456-6213
Practice Address - Fax:907-452-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000736Medicaid