Healthcare Provider Details

I. General information

NPI: 1780906305
Provider Name (Legal Business Name): MICHELLE DOCKINS KOCAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 2ND ST
CORDOVA AK
99574-2196
US

IV. Provider business mailing address

PO BOX 2196
CORDOVA AK
99574-2196
US

V. Phone/Fax

Practice location:
  • Phone: 907-429-7797
  • Fax:
Mailing address:
  • Phone: 907-429-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK 138
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: