Provider Demographics
NPI:1790323632
Name:ANODYNE PAIN & WELLNESS OF ANCHORAGE LLC
Entity Type:Organization
Organization Name:ANODYNE PAIN & WELLNESS OF ANCHORAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDD
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-995-1622
Mailing Address - Street 1:500 E BENSON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4148
Mailing Address - Country:US
Mailing Address - Phone:907-561-4474
Mailing Address - Fax:
Practice Address - Street 1:500 E BENSON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4148
Practice Address - Country:US
Practice Address - Phone:907-561-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty