Provider Demographics
NPI:1700085446
Name:CRANDALL, JOEL (MST, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MST, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 VICLAND PLACE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606
Mailing Address - Country:US
Mailing Address - Phone:310-395-3668
Mailing Address - Fax:310-395-3668
Practice Address - Street 1:2436 FEDERAL AVE
Practice Address - Street 2:# 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2960
Practice Address - Country:US
Practice Address - Phone:310-395-3668
Practice Address - Fax:310-395-3668
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist