Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 434 | ND |
NPI | 1003928797 |
---|---|
Provider Name | Dr. Craig L Kendall |
First Address | Ellendale, ND 58436-0159 |
Second Address | Ellendale, ND 58436-0159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 05/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015054 | (05) | ND |
7602400 | (05) | SD |
S1179 | RR MEDICARE (01) | |
T78836 | (02) |