Provider Demographics
NPI:1679634695
Name:GRANETO, JAMES J (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:GRANETO
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7291 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7317
Mailing Address - Country:US
Mailing Address - Phone:330-758-5119
Mailing Address - Fax:330-758-5195
Practice Address - Street 1:7291 WEST BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7317
Practice Address - Country:US
Practice Address - Phone:330-758-5119
Practice Address - Fax:330-758-5195
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH762111NX0800X
WV645111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0434891Medicaid
WV0131208-000Medicaid
WV0131208-000Medicaid
OHT47121Medicare UPIN
OH0434891Medicaid