Healthcare Provider Details

I. General information

NPI: 1467500801
Provider Name (Legal Business Name): ALASKA INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 ARCTIC BLVD SUITE 101
ANCHORAGE AK
99503-7007
US

IV. Provider business mailing address

5001 ARCTIC BLVD SUITE 101
ANCHORAGE AK
99503-7007
US

V. Phone/Fax

Practice location:
  • Phone: 907-337-4246
  • Fax:
Mailing address:
  • Phone: 907-337-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number69
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT 1181
License Number StateAK

VIII. Authorized Official

Name: DAVID VALENTINE COSGRAVE
Title or Position: PRESIDENT
Credential:
Phone: 907-337-4246