Provider Demographics
NPI:1083159164
Name:NORTH STAR ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:NORTH STAR ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ILIFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:907-406-0834
Mailing Address - Street 1:6600 E 6TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1770
Mailing Address - Country:US
Mailing Address - Phone:907-406-0834
Mailing Address - Fax:
Practice Address - Street 1:630 E 57TH PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1305
Practice Address - Country:US
Practice Address - Phone:907-791-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK116862261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service