Provider Demographics
NPI:1023137783
Name:KELVIN, DEBRA SUE (L AC, DIPL AC)
Entity type:Individual
Prefix:
First Name:DEBRA SUE
Middle Name:
Last Name:KELVIN
Suffix:
Gender:F
Credentials:L AC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 ADDISON STREET
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710
Mailing Address - Country:US
Mailing Address - Phone:510-334-2472
Mailing Address - Fax:
Practice Address - Street 1:743 ADDISON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1945
Practice Address - Country:US
Practice Address - Phone:510-334-2472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist