Provider Demographics
NPI:1689914160
Name:MANDEL, JUSTIN (LAC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MANDEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 W JORDAN ST STE 124
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1740
Mailing Address - Country:US
Mailing Address - Phone:850-485-5535
Mailing Address - Fax:888-490-2942
Practice Address - Street 1:14 W JORDAN ST STE 124
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1740
Practice Address - Country:US
Practice Address - Phone:850-485-5535
Practice Address - Fax:888-490-2942
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002379-1171100000X
FLAP3562171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist