Basic Information
| Provider Information | |||||||||
| NPI: | 1760736060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALSA | ||||||||
| FirstName: | SATNARAYAN | ||||||||
| MiddleName: | SINGH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT, DC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KHALSA | ||||||||
| OtherFirstName: | RYAN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT, DPT, DC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 SHATTUCK WAY | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037816613 | ||||||||
| FaxNumber: | 6033363766 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SHATTUCK WAY | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034316677 | ||||||||
| FaxNumber: | 6036102232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2012 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 895 | NH | N | Chiropractic Providers | Chiropractor | 225100000X | 4828 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.