Provider Demographics
NPI:1407339203
Name:STILL, JILL CHRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:STILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885B LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7927
Mailing Address - Country:US
Mailing Address - Phone:907-796-9984
Mailing Address - Fax:855-756-1810
Practice Address - Street 1:1601 SALMON CREEK LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7867
Practice Address - Country:US
Practice Address - Phone:907-796-9984
Practice Address - Fax:855-756-1810
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-08
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK137180171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1096383OtherBUSINESS LICENSE NUMBER