MEDICARE: LUMINARY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	446	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518191345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINARY LLC

Provider Business Mailing Address
First Line	:	1838 W NORTHERN LIGHTS BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-3342
Country	:	US
Telephone Number	:	907-279-1838
Fax Number	:	907-279-1811

Provider Business Practice Location Address
First Line	:	1838 W NORTHERN LIGHTS BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-3342
Country	:	US
Telephone Number	:	907-279-1838
Fax Number	:	907-279-1811

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PATTY J CHASE
Credential	:
Telephone Number	:	907-279-1838

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	05/07/2009

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Directions to “LUMINARY LLC ” Practice Location

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