Provider Demographics
NPI:1306194253
Name:GRANZOW, CATHERINE PEARL (DC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PEARL
Last Name:GRANZOW
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-0147
Mailing Address - Country:US
Mailing Address - Phone:716-548-1648
Mailing Address - Fax:716-304-1605
Practice Address - Street 1:9 N HARTLAND ST
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-1003
Practice Address - Country:US
Practice Address - Phone:716-548-1648
Practice Address - Fax:716-304-1605
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor