Provider Demographics
NPI:1114552254
Name:ALKEMY ACUPUNCTURE & INTEGRATIVE MEDICINE, INC.
Entity type:Organization
Organization Name:ALKEMY ACUPUNCTURE & INTEGRATIVE MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:MITTELSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, DC, LAC,
Authorized Official - Phone:213-222-6077
Mailing Address - Street 1:700 W 9TH ST APT 2418
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4545
Mailing Address - Country:US
Mailing Address - Phone:213-222-6077
Mailing Address - Fax:
Practice Address - Street 1:700 W 9TH ST APT 2418
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4545
Practice Address - Country:US
Practice Address - Phone:213-222-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty