Provider Demographics
NPI:1750653572
Name:GRANGER, DENA DELVARON (DC)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:DELVARON
Last Name:GRANGER
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 1:76 TABB DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058
Mailing Address - Country:US
Mailing Address - Phone:901-840-2234
Mailing Address - Fax:901-840-2237
Practice Address - Street 1:3615 S HOUSTON LEVEE RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9192
Practice Address - Country:US
Practice Address - Phone:901-221-7173
Practice Address - Fax:901-221-7934
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025029Medicaid