Healthcare Provider Details

I. General information

NPI: 1427438225
Provider Name (Legal Business Name): ANCHORAGE WELLNESS GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 OLD SEWARD HWY SUITE #102
ANCHORAGE AK
99518-3349
US

IV. Provider business mailing address

3813 S RIVER DR
TEMPE AZ
85282-5924
US

V. Phone/Fax

Practice location:
  • Phone: 907-522-7466
  • Fax: 907-522-7467
Mailing address:
  • Phone: 480-227-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number460
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number460
License Number StateAK

VIII. Authorized Official

Name: DR. BRIAN L. GLAUS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 480-227-6841