Provider Demographics
NPI:1265596563
Name:CRANDALL GILLIES, KATHY L (DC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:L
Last Name:CRANDALL GILLIES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:CRANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93225-2407
Mailing Address - Country:US
Mailing Address - Phone:661-993-4989
Mailing Address - Fax:
Practice Address - Street 1:3121 MT PINOS WAY STE D
Practice Address - Street 2:
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225-8083
Practice Address - Country:US
Practice Address - Phone:661-993-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0276640Medicare ID - Type Unspecified