Provider Demographics
NPI:1467077065
Name:JUSTICE, KANDI (DIPL OM)
Entity Type:Individual
Prefix:MRS
First Name:KANDI
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:DIPL OM
Other - Prefix:MISS
Other - First Name:KANDI
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 S ONEIDA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2550
Mailing Address - Country:US
Mailing Address - Phone:941-467-9872
Mailing Address - Fax:
Practice Address - Street 1:2121 S ONEIDA ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2550
Practice Address - Country:US
Practice Address - Phone:941-467-9872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
169388OtherNCCAOM CERTIFICATION
COACU.0002580OtherACUPUNCTURE LICENSE