Provider Demographics
NPI:1053621748
Name:KIRK, JOAN (ND)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11041 GAMACHE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1648
Mailing Address - Country:US
Mailing Address - Phone:907-746-5475
Mailing Address - Fax:866-603-8234
Practice Address - Street 1:642 S ALASKA ST
Practice Address - Street 2:SUITE 204B
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6342
Practice Address - Country:US
Practice Address - Phone:907-746-5475
Practice Address - Fax:866-603-8234
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK70175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath