Provider Demographics
NPI:1265952360
Name:HENSLEY, ELAINE M (PHD, DIPL OM, LAC)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PHD, DIPL OM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 W CALLE DEL SOL APT 1
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1638
Mailing Address - Country:US
Mailing Address - Phone:818-288-1164
Mailing Address - Fax:
Practice Address - Street 1:2060 E. ROUTE 66
Practice Address - Street 2:SUITE 201 (INSIDE LOTUS HEALTH & WELLNESS)
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-9174
Practice Address - Country:US
Practice Address - Phone:818-288-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73264225700000X
CA17647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17647OtherCA LICENSE
CA821608297OtherEIN NUMBER