Provider Demographics
NPI:1083971840
Name:GRANN, BREANNE L (DC)
Entity Type:Individual
Prefix:DR
First Name:BREANNE
Middle Name:L
Last Name:GRANN
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 1:3547 MAIN ST NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4224
Mailing Address - Country:US
Mailing Address - Phone:612-236-5035
Mailing Address - Fax:612-465-2909
Practice Address - Street 1:3547 MAIN ST NE
Practice Address - Street 2:SUITE 1
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4224
Practice Address - Country:US
Practice Address - Phone:612-236-5035
Practice Address - Fax:612-465-2909
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor