Kenneth Grant Mittelstadt, DACM, DC, L.AC.
Individual provider Active NPI Acupuncturist · Selma, TX
NPI 1659914992 · NPPES record last updated Nov 30, 2022
Key facts
- NPI
- 1659914992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- AC02078 (TX)
- Practice address
- 8088 Old Austin Rd Unit 2a
Selma, TX 78154-3377 - Phone
- (830) 743-9663
- NPI assigned
- Oct 18, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18282 | CA | MD | Professional Counselor |
| AC02078 | TX | MD | Acupuncturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist |
171100000X | 18282 | CA | |
| Acupuncturist | 171100000X | AC02078 | TX | Yes |
Addresses
Primary practice location
8088 Old Austin Rd Unit 2a
Selma, TX 78154-3377
Mailing address
8088 Old Austin Rd Unit 2a
Selma, TX 78154-3377
Phone (830) 743-9663
Other providers in Selma, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.