1265596563 NPI number — DR. KATHY L CRANDALL GILLIES D.C.

Table of content: HAILEY TARDIF (NPI 1205606464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265596563 NPI number — DR. KATHY L CRANDALL GILLIES D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANDALL GILLIES
Provider First Name:
KATHY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRANDALL
Provider Other First Name:
KATHY
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265596563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAZIER PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93225-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-993-4989
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3121 MT PINOS WAY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAZIER PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93225-8083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-993-4989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC27664 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com