Healthcare Provider Details

I. General information

NPI: 1457887812
Provider Name (Legal Business Name): STEPHANIE PHILLIPS LA.C, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 HUFFMAN PARK DR STE 140
ANCHORAGE AK
99515-3534
US

IV. Provider business mailing address

3330 EAGLE ST
ANCHORAGE AK
99503-4146
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-6122
  • Fax: 907-205-5740
Mailing address:
  • Phone: 907-561-2330
  • Fax: 907-561-1282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number200191
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number112760
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number112760
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: