Most Relevant Information
Provider Data
| NPI Number: | 1003394263 |
| Provider Name: | CHANDRA DAWN JUSTICE MMP |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 157062 |
Most Important Dates
| Enumeration Date: | 07/31/2018 |
| Last Updated: | 07/31/2018 |
Provider Practice Location
101 N KEMP AVE
TISHOMINGO
OK
734601719
Practice Location Phone/Fax
| Phone: | 5803717362 |
| Fax: |
Provider Mailing Location
807 N BYRD ST
TISHOMINGO
OK
734601411
Provider Mailing Phone/Fax
| Phone: | 5803717362 |
| Fax: |