Provider Demographics
NPI:1356677223
Name:CRANDALL, THERESA BROWN (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:BROWN
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:BROWN
Other - Last Name:CRANDALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:13910 FIVAY RD
Mailing Address - Street 2:STE. 10
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7154
Mailing Address - Country:US
Mailing Address - Phone:727-862-3509
Mailing Address - Fax:727-862-3500
Practice Address - Street 1:13910 FIVAY RD
Practice Address - Street 2:STE. 10
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7154
Practice Address - Country:US
Practice Address - Phone:727-862-3509
Practice Address - Fax:727-862-3500
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10521111N00000X
GACHIRO08571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor