Provider Demographics
NPI:1316038474
Name:GILLESPIE, KANDI L (DC)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:L
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KANDI
Other - Middle Name:L
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35549-0187
Mailing Address - Country:US
Mailing Address - Phone:205-924-0050
Mailing Address - Fax:205-924-0065
Practice Address - Street 1:32020 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:CARBON HILL
Practice Address - State:AL
Practice Address - Zip Code:35549
Practice Address - Country:US
Practice Address - Phone:205-924-0050
Practice Address - Fax:205-924-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529900540Medicaid
AL51532604OtherBC/BS
AL051532604NIXMedicare ID - Type Unspecified
AL51532604OtherBC/BS