Provider Demographics
NPI:1013985365
Name:CRANDALL, SHIRLEY ANNA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANNA
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2342
Mailing Address - Country:US
Mailing Address - Phone:508-771-0430
Mailing Address - Fax:
Practice Address - Street 1:1047 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2342
Practice Address - Country:US
Practice Address - Phone:508-771-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1602292Medicaid
MA1602292Medicaid