{
"Npi": {
"NPI": "1295494193",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KELAIDIS",
"FirstName": "ELENI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 370",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARFA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79843-0370",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-352-1895",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "905 W SAN ANTONIO ST",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "MARFA",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79843",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "720-362-1895",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/08/2021",
"LastUpdateDate": "10/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "AC02123",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "ACU.0002724",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}