Provider Demographics
NPI:1780861534
Name:ERETH, KENDALL SHANNON (DC)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:SHANNON
Last Name:ERETH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 W THUNDERBIRD RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4602
Mailing Address - Country:US
Mailing Address - Phone:623-773-0505
Mailing Address - Fax:
Practice Address - Street 1:8251 W THUNDERBIRD RD STE 120
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4602
Practice Address - Country:US
Practice Address - Phone:623-773-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor