Provider Demographics
NPI:1659392777
Name:CRANDELL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:CRANDELL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-335-9300
Mailing Address - Street 1:6530 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9757
Mailing Address - Country:US
Mailing Address - Phone:831-335-9300
Mailing Address - Fax:831-335-9304
Practice Address - Street 1:6530 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9757
Practice Address - Country:US
Practice Address - Phone:831-335-9300
Practice Address - Fax:831-335-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty