Provider Demographics
NPI:1093748485
Name:GRANITE RUN CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:GRANITE RUN CHIROPRACTIC LTD
Other - Org Name:CHIRO PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-656-5422
Mailing Address - Street 1:93A W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-1803
Mailing Address - Country:US
Mailing Address - Phone:717-656-5422
Mailing Address - Fax:717-656-5403
Practice Address - Street 1:93A W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1803
Practice Address - Country:US
Practice Address - Phone:717-656-5422
Practice Address - Fax:717-656-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty