Provider Demographics
NPI:1629269386
Name:KHALSA CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KHALSA CHIROPRACTIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MHA ATMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-857-1277
Mailing Address - Street 1:5880 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6627
Mailing Address - Country:US
Mailing Address - Phone:323-857-1277
Mailing Address - Fax:323-857-1574
Practice Address - Street 1:5880 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6627
Practice Address - Country:US
Practice Address - Phone:323-857-1277
Practice Address - Fax:323-857-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty