Provider Demographics
NPI:1821058751
Name:GRANAT, EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:GRANAT
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 1:1638 S AMARIAS DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4281
Mailing Address - Country:US
Mailing Address - Phone:847-243-2110
Mailing Address - Fax:847-243-2118
Practice Address - Street 1:350 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3192
Practice Address - Country:US
Practice Address - Phone:847-243-2110
Practice Address - Fax:847-243-2118
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21079Medicare ID - Type Unspecified