Provider Demographics
NPI:1235684416
Name:CUNNINGHAM, JESSE FRANK (LAC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:FRANK
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 82ND AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3100
Mailing Address - Country:US
Mailing Address - Phone:907-245-7669
Mailing Address - Fax:907-245-7670
Practice Address - Street 1:615 E 82ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3100
Practice Address - Country:US
Practice Address - Phone:619-564-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113734171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist