Provider Demographics
NPI:1811228240
Name:KOKKALIS, ANGELICA D (DOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:D
Last Name:KOKKALIS
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WESTWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:W. LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906
Mailing Address - Country:US
Mailing Address - Phone:765-497-0817
Mailing Address - Fax:765-807-2914
Practice Address - Street 1:124 WESTWOOD DR.
Practice Address - Street 2:
Practice Address - City:W. LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906
Practice Address - Country:US
Practice Address - Phone:765-497-0817
Practice Address - Fax:765-807-2914
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000081A ACUPUNTURI171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist