Provider Demographics
NPI:1639761695
Name:BHATTI, SURYA SINGH (DC)
Entity Type:Individual
Prefix:DR
First Name:SURYA
Middle Name:SINGH
Last Name:BHATTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 UNIVERSITY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7608
Mailing Address - Country:US
Mailing Address - Phone:408-960-9909
Mailing Address - Fax:
Practice Address - Street 1:718 UNIVERSITY AVE STE 110
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7608
Practice Address - Country:US
Practice Address - Phone:408-960-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor