Provider Demographics
NPI:1548546716
Name:DR. AMY M CYNOWA DC PC
Entity type:Organization
Organization Name:DR. AMY M CYNOWA DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CYNOWA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-563-7662
Mailing Address - Street 1:3333 DENALI ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4038
Mailing Address - Country:US
Mailing Address - Phone:907-563-7662
Mailing Address - Fax:907-562-7662
Practice Address - Street 1:3333 DENALI ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4038
Practice Address - Country:US
Practice Address - Phone:907-563-7662
Practice Address - Fax:907-562-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK393261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service