Provider Demographics
NPI:1639293616
Name:MEDDLETON & BERG LLC
Entity Type:Organization
Organization Name:MEDDLETON & BERG LLC
Other - Org Name:ALASKA CENTER FOR ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MEDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:907-745-8688
Mailing Address - Street 1:642 S ALASKA ST STE 208
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6378
Mailing Address - Country:US
Mailing Address - Phone:907-745-8688
Mailing Address - Fax:907-745-8987
Practice Address - Street 1:642 S ALASKA ST STE 208
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6378
Practice Address - Country:US
Practice Address - Phone:907-745-8688
Practice Address - Fax:907-745-8987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK087171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty