Healthcare Provider Details

I. General information

NPI: 1265596563
Provider Name (Legal Business Name): KATHY L CRANDALL GILLIES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHY L CRANDALL DC

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 MT PINOS WAY STE D
FRAZIER PARK CA
93225-8083
US

IV. Provider business mailing address

PO BOX 2407
FRAZIER PARK CA
93225-2407
US

V. Phone/Fax

Practice location:
  • Phone: 661-993-4989
  • Fax:
Mailing address:
  • Phone: 661-993-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: