Healthcare Provider Details

I. General information

NPI: 1366901159
Provider Name (Legal Business Name): LUMINARY INTEGRATED HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W BENSON BLVD STE 101
ANCHORAGE AK
99517-1973
US

IV. Provider business mailing address

1900 W BENSON BLVD STE 101
ANCHORAGE AK
99517-1973
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-1838
  • Fax: 907-278-1811
Mailing address:
  • Phone: 907-279-1838
  • Fax: 907-278-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDD WATTENBARGER
Title or Position: OWNER
Credential: DC
Phone: 907-279-1838