Provider Demographics
NPI:1962143511
Name:ST JOHN RONGITSCH, KORINA K (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:KORINA
Middle Name:K
Last Name:ST JOHN RONGITSCH
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:KORINA
Other - Middle Name:KAY
Other - Last Name:ST JOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DR STE B-215
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7373
Mailing Address - Country:US
Mailing Address - Phone:989-720-4325
Mailing Address - Fax:
Practice Address - Street 1:2323 S TRUNK RD
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-5940
Practice Address - Country:US
Practice Address - Phone:989-720-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2018-01171100000X
AK40672171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist