Provider Demographics
NPI:1093426462
Name:GRANITE FAMILY CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:GRANITE FAMILY CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EGGEBRAATEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-227-0542
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-0093
Mailing Address - Country:US
Mailing Address - Phone:320-564-1209
Mailing Address - Fax:320-564-1210
Practice Address - Street 1:868 PRENTICE ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1521
Practice Address - Country:US
Practice Address - Phone:320-564-1209
Practice Address - Fax:320-564-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty