Healthcare Provider Details

I. General information

NPI: 1093446916
Provider Name (Legal Business Name): PURE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 LAKE OTIS PKWY
ANCHORAGE AK
99508-5223
US

IV. Provider business mailing address

305 SKWENTNA DR
ANCHORAGE AK
99504-4887
US

V. Phone/Fax

Practice location:
  • Phone: 907-960-1661
  • Fax:
Mailing address:
  • Phone: 907-960-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELANIE CHRISTINA CHARLEY
Title or Position: OWNER
Credential: DACM
Phone: 907-960-1661