Provider Demographics
NPI:1841013448
Name:GLENDENING, KERRY (DTCM, LAC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:GLENDENING
Suffix:
Gender:F
Credentials:DTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ANNIE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3493
Mailing Address - Country:US
Mailing Address - Phone:831-334-0054
Mailing Address - Fax:
Practice Address - Street 1:2222 E CLIFF DR STE 216
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4739
Practice Address - Country:US
Practice Address - Phone:831-708-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist