Provider Demographics
NPI:1003857608
Name:GRANGER, ANDREW JASON (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JASON
Last Name:GRANGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 S 3 BS AND K RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9756
Mailing Address - Country:US
Mailing Address - Phone:740-965-5856
Mailing Address - Fax:
Practice Address - Street 1:2115 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2022
Practice Address - Country:US
Practice Address - Phone:614-888-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000299311OtherANTHEM BCBS
OH2180045Medicaid
OHU81474Medicare UPIN
OH000000299311OtherANTHEM BCBS