Provider Demographics
NPI:1699147850
Name:DENSLOW, KERRY
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:DENSLOW
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 1:4362 N ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1222
Mailing Address - Country:US
Mailing Address - Phone:619-757-0220
Mailing Address - Fax:215-754-6706
Practice Address - Street 1:4362 N ROGERS RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1222
Practice Address - Country:US
Practice Address - Phone:619-757-0220
Practice Address - Fax:215-754-6706
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12252171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist