Wyatt Berg, DC – Chiropractor in Fairbanks, AK

Key facts

NPI: 1750169082
Entity type: Individual (NPI type 1)
Primary specialty: Chiropractor 111N00000X
License: 214767 (AK)
Practice address: 515 7TH Ave Ste 230
Fairbanks, AK 99701-4949
Phone: (907) 456-4234
Fax: (907) 451-9168
NPI assigned: Sep 18, 2023
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Spaulding Chiropractic Clinic Inc Chiropractor · Fairbanks, AK · NPI 1437273125

Medicare reassignment Care Compare group NPD AK · CHIROPRACTOR

Medicare Care Compare profile

Specialty: Chiropractic
Education: Other, 2023
Medicare assignment: May accept Medicare assignment
Group practices: Spaulding Chiropractic Clinic Inc (4 clinicians)

Practice addresses (Care Compare)

515 7TH Ave
Suite 230
Fairbanks, AK 99701-4949
Phone (907) 456-4234

Medicare participation

Medicare fee-for-service enrollment: Enrolled in AK

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20240611003300	AK	Practitioner - Chiropractic	5799227203	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
214767	AK	MD	Chiropractor

Practice roles

Organization	Specialty	Status	New patients
Spaulding Chiropractic Clinic Inc	Chiropractor	Current since Apr 14, 2024	Accepting new patients

Locations

515 7th Ave
Ste 230
Fairbanks, AK 99701
Phone (907) 456-4234

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor	111N00000X	214767	AK	Yes

Addresses

Primary practice location

515 7TH Ave Ste 230
Fairbanks, AK 99701-4949

Mailing address

515 7TH Ave Ste 230
Fairbanks, AK 99701-4949
Phone (907) 456-4234

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 18, 2023.

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1750169082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 7TH AVE STE 230",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014949",
            "telephone_number": "907-456-4234",
            "fax_number": "907-451-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 7TH AVE STE 230",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014949",
            "telephone_number": "907-456-4234",
            "fax_number": "907-451-9168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "WYATT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-18",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AK",
            "license": "214767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

All providers in Fairbanks, AK · Chiropractor in Alaska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.