Provider Demographics
NPI:1437406006
Name:JUENKE, JOEL (LAC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:JUENKE
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 1:1221 NOBLE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4961
Mailing Address - Country:US
Mailing Address - Phone:720-399-4279
Mailing Address - Fax:
Practice Address - Street 1:1221 NOBLE ST STE 101
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4961
Practice Address - Country:US
Practice Address - Phone:720-399-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK152171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist