Provider Demographics
NPI:1467500801
Name:ALASKA INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:ALASKA INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:COSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-337-4246
Mailing Address - Street 1:5001 ARCTIC BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7007
Mailing Address - Country:US
Mailing Address - Phone:907-337-4246
Mailing Address - Fax:
Practice Address - Street 1:5001 ARCTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7007
Practice Address - Country:US
Practice Address - Phone:907-337-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK69171100000X
AKMT 1181225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty