Provider Demographics
NPI:1497230353
Name:ACUPUNCTURE & WELLNESS OF CORDOVA
Entity Type:Organization
Organization Name:ACUPUNCTURE & WELLNESS OF CORDOVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DOCKINS
Authorized Official - Last Name:KOCAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:907-429-7797
Mailing Address - Street 1:PO BOX 2196
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-2196
Mailing Address - Country:US
Mailing Address - Phone:907-429-7797
Mailing Address - Fax:
Practice Address - Street 1:520 2ND STREET
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574
Practice Address - Country:US
Practice Address - Phone:907-429-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty