Provider Demographics
NPI:1336457415
Name:SNOW BLOSSOM ACUPUNCTURE
Entity Type:Organization
Organization Name:SNOW BLOSSOM ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:907-245-7669
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:SUITE 302
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3100
Practice Address - Country:US
Practice Address - Phone:907-245-7669
Practice Address - Fax:907-245-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty