Provider Demographics
NPI:1588613525
Name:GRANO, ANDREW D (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:GRANO
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 1:108 STATE RT 23
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1827
Mailing Address - Country:US
Mailing Address - Phone:973-827-0003
Mailing Address - Fax:973-827-0063
Practice Address - Street 1:108 STATE RT 23
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-1827
Practice Address - Country:US
Practice Address - Phone:973-827-0003
Practice Address - Fax:973-827-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00596200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU90962Medicare UPIN
NJ136676Medicare PIN