Provider Demographics
NPI:1003985326
Name:KANDALAFT, JOE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:KANDALAFT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 FLORENCE AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240
Mailing Address - Country:US
Mailing Address - Phone:562-806-6763
Mailing Address - Fax:562-806-6764
Practice Address - Street 1:7340 FLORENCE AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240
Practice Address - Country:US
Practice Address - Phone:562-806-6763
Practice Address - Fax:562-806-6764
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC206500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC20650Medicare UPIN
CAD00020650Medicare ID - Type Unspecified