Provider Demographics
NPI:1982721452
Name:CRANDELL, KERRI (DC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9757
Mailing Address - Country:US
Mailing Address - Phone:831-335-9300
Mailing Address - Fax:
Practice Address - Street 1:6530 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9757
Practice Address - Country:US
Practice Address - Phone:831-335-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80489Medicare UPIN
CADC0267010Medicare ID - Type Unspecified