Provider Demographics
NPI:1699904599
Name:JUSTESEN, KRIS (OMD, ND, LAC)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:JUSTESEN
Suffix:
Gender:F
Credentials:OMD, ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2822
Mailing Address - Country:US
Mailing Address - Phone:801-263-9380
Mailing Address - Fax:
Practice Address - Street 1:1664 DAWN DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2822
Practice Address - Country:US
Practice Address - Phone:801-263-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101052-1201171100000X
CAAC3838171100000X
IDPENDING175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath