Healthcare Provider Details

I. General information

NPI: 1013323773
Provider Name (Legal Business Name): COURTNEY BEDDOW LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368000 KENDANEMKEN RD
SOLDOTNA AK
99669
US

IV. Provider business mailing address

PO BOX 4143
SOLDOTNA AK
99669-4143
US

V. Phone/Fax

Practice location:
  • Phone: 907-252-3876
  • Fax:
Mailing address:
  • Phone: 907-252-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number49
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: