Provider Demographics
NPI:1215360086
Name:ACUTRIBE LLC
Entity Type:Organization
Organization Name:ACUTRIBE LLC
Other - Org Name:ACUTRIBE COMMUNITY ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:907-458-7423
Mailing Address - Street 1:1231 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4926
Mailing Address - Country:US
Mailing Address - Phone:907-458-7423
Mailing Address - Fax:907-452-1231
Practice Address - Street 1:1231 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4926
Practice Address - Country:US
Practice Address - Phone:907-458-7423
Practice Address - Fax:907-452-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121171100000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty