Provider Demographics
NPI:1528756913
Name:GRANNIS, KENDALL MARIE
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIE
Last Name:GRANNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 SW DISK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3060
Mailing Address - Country:US
Mailing Address - Phone:541-639-8911
Mailing Address - Fax:
Practice Address - Street 1:999 SW DISK DR STE 105
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3060
Practice Address - Country:US
Practice Address - Phone:541-639-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC217284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist