Provider Demographics
NPI:1407599699
Name:BHAKTA, BINNY JAYESH (DC)
Entity type:Individual
Prefix:
First Name:BINNY
Middle Name:JAYESH
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 ORCUTT RD APT 105
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6836
Mailing Address - Country:US
Mailing Address - Phone:559-759-1345
Mailing Address - Fax:
Practice Address - Street 1:5501 N LAMAR BLVD STE C111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1076
Practice Address - Country:US
Practice Address - Phone:512-766-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15332111N00000X
CA35095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor