Provider Demographics
NPI:1790291672
Name:KUNC, ERIC (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KUNC
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 OLD SEWARD HWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6065
Mailing Address - Country:US
Mailing Address - Phone:907-646-7653
Mailing Address - Fax:
Practice Address - Street 1:4007 OLD SEWARD HWY STE 1000
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6065
Practice Address - Country:US
Practice Address - Phone:907-646-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101895OtherMASSAGE THERAPY