Healthcare Provider Details

I. General information

NPI: 1740968197
Provider Name (Legal Business Name): BALANCED BODYWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 LAKE OTIS PKWY STE A
ANCHORAGE AK
99508-5237
US

IV. Provider business mailing address

2217 E TUDOR ROAD, SUITE 33
ANCHORAGE AK
99507-1068
US

V. Phone/Fax

Practice location:
  • Phone: 907-519-8049
  • Fax: 907-782-4148
Mailing address:
  • Phone: 907-519-8049
  • Fax: 907-782-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA NOSICH
Title or Position: OWNER/PROVDER
Credential: LMT
Phone: 907-519-8049