Provider Demographics
NPI:1558716977
Name:KILTAYA NATURAL MEDICINE, INC.
Entity Type:Organization
Organization Name:KILTAYA NATURAL MEDICINE, INC.
Other - Org Name:BODY STRESS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-226-3787
Mailing Address - Street 1:379 AMHERST ST.
Mailing Address - Street 2:PMB 130
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063
Mailing Address - Country:US
Mailing Address - Phone:978-226-3787
Mailing Address - Fax:480-582-0441
Practice Address - Street 1:0 PROFILE CIR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1716
Practice Address - Country:US
Practice Address - Phone:978-226-3787
Practice Address - Fax:480-582-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH132175F00000X
AZ15-1511175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty