Healthcare Provider Details

I. General information

NPI: 1659392777
Provider Name (Legal Business Name): CRANDELL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 HIGHWAY 9
FELTON CA
95018-9757
US

IV. Provider business mailing address

6530 HIGHWAY 9
FELTON CA
95018-9757
US

V. Phone/Fax

Practice location:
  • Phone: 831-335-9300
  • Fax: 831-335-9304
Mailing address:
  • Phone: 831-335-9300
  • Fax: 831-335-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number26701
License Number StateCA

VIII. Authorized Official

Name: DR. KERRI ANN CRANDELL
Title or Position: PRESIDENT
Credential: DC
Phone: 831-335-9300