Provider Demographics
NPI:1275750911
Name:HALVERSON, ODA (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:ODA
Middle Name:
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25550 HAWTHORNE BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6832
Mailing Address - Country:US
Mailing Address - Phone:301-465-0337
Mailing Address - Fax:310-465-0237
Practice Address - Street 1:25550 HAWTHORNE BLVD STE 314
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6832
Practice Address - Country:US
Practice Address - Phone:301-465-0337
Practice Address - Fax:310-465-0237
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC3318Medicare UPIN