Provider Demographics
NPI:1578132866
Name:GRANZOTTO, FORREST PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:PATRICK
Last Name:GRANZOTTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 BERNARDO PLAZA CT STE 351
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2426
Mailing Address - Country:US
Mailing Address - Phone:858-673-1733
Mailing Address - Fax:
Practice Address - Street 1:11770 BERNARDO PLAZA CT STE 351
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2426
Practice Address - Country:US
Practice Address - Phone:858-673-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor