Provider Demographics
NPI:1093915985
Name:GRANO CHIROPRACTIC CENTER OF ANDOVER, LLC
Entity Type:Organization
Organization Name:GRANO CHIROPRACTIC CENTER OF ANDOVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANO
Authorized Official - Suffix:
Authorized Official - Credentials:D C ,CCSP
Authorized Official - Phone:973-383-5533
Mailing Address - Street 1:61 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2745
Mailing Address - Country:US
Mailing Address - Phone:973-383-5533
Mailing Address - Fax:
Practice Address - Street 1:61 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2745
Practice Address - Country:US
Practice Address - Phone:973-383-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00635500NJ385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care