Provider Demographics
NPI:1093855751
Name:KANDI JEAN MARQUARDT INC.
Entity Type:Organization
Organization Name:KANDI JEAN MARQUARDT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUARDT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CNMT
Authorized Official - Phone:719-635-8809
Mailing Address - Street 1:2111 TEMPLETON GAP RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7154
Mailing Address - Country:US
Mailing Address - Phone:719-635-8809
Mailing Address - Fax:
Practice Address - Street 1:2111 TEMPLETON GAP RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7154
Practice Address - Country:US
Practice Address - Phone:719-635-8809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-11-05
Deactivation Date:2008-08-08
Deactivation Code:
Reactivation Date:2009-11-05
Provider Licenses
StateLicense IDTaxonomies
CO130870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty