Provider Demographics
NPI:1265468896
Name:ANDREW & CARRIE GRANGER CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ANDREW & CARRIE GRANGER CHIROPRACTIC, INC
Other - Org Name:POLARIS NEIGHBORHOOD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-888-3500
Mailing Address - Street 1:2115 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2022
Mailing Address - Country:US
Mailing Address - Phone:614-888-3500
Mailing Address - Fax:614-468-0200
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:614-468-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9337941Medicare PIN