Provider Demographics
NPI:1780962639
Name:A&E, INC.
Entity type:Organization
Organization Name:A&E, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:MANNINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-474-0636
Mailing Address - Street 1:201 OLD STEESE HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3160
Mailing Address - Country:US
Mailing Address - Phone:907-474-0636
Mailing Address - Fax:907-474-0637
Practice Address - Street 1:201 OLD STEESE HWY
Practice Address - Street 2:STE 4
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3123
Practice Address - Country:US
Practice Address - Phone:907-474-0636
Practice Address - Fax:907-474-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty