Provider Demographics
NPI:1598252744
Name:GRANVILLE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GRANVILLE CHIROPRACTIC LLC
Other - Org Name:INTEGRATED HEALTH CENTERS - GRANVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMPFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-726-5043
Mailing Address - Street 1:230 EAST BROADWAY
Mailing Address - Street 2:SUITE # 150
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023
Mailing Address - Country:US
Mailing Address - Phone:740-920-4749
Mailing Address - Fax:
Practice Address - Street 1:230 EAST BROADWAY
Practice Address - Street 2:SUITE # 150
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43203
Practice Address - Country:US
Practice Address - Phone:740-920-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty