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General NPI Number Information
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NPI Number | 1487827978
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Entity Type | Organization
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Legal Business Name | KENNETH CRANDELL, D.C.
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 11657 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97220-2264
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Country | US
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Telephone | 503-252-5118
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Fax | 503-252-3199
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Provider Business Mailing Address
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Address Line | 11657 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97220-2264
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Country | US
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Telephone | 503-252-5118
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Fax | 503-252-3199
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH LEE CRANDELL
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Credential | D.C.
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Telephone | 503-252-5118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1923
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License Number State | OR
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