Provider Demographics
NPI:1750567855
Name:ADI SHAKTI ACUPUNCTURE INC.
Entity type:Organization
Organization Name:ADI SHAKTI ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAPA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-929-2794
Mailing Address - Street 1:228 CAMINO MIRAMONTES
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-8060
Mailing Address - Country:US
Mailing Address - Phone:505-929-2794
Mailing Address - Fax:866-469-9410
Practice Address - Street 1:228 CAMINO MIRAMONTES
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8060
Practice Address - Country:US
Practice Address - Phone:505-929-2794
Practice Address - Fax:866-469-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM854 RX2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty