Healthcare Provider Details

I. General information

NPI: 1265952360
Provider Name (Legal Business Name): ELAINE M HENSLEY PHD, DIPL. O.M., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 E. ROUTE 66 SUITE 201 (INSIDE LOTUS HEALTH & WELLNESS)
GLENDORA CA
91740-9174
US

IV. Provider business mailing address

1168 W CALLE DEL SOL APT 1
AZUSA CA
91702-1638
US

V. Phone/Fax

Practice location:
  • Phone: 818-288-1164
  • Fax:
Mailing address:
  • Phone: 818-288-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73264
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: