Provider Demographics
NPI:1851161343
Name:BROWN, GRANGER (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANGER
Middle Name:
Last Name:BROWN
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 1:1900 WASHINGTON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6850
Mailing Address - Country:US
Mailing Address - Phone:801-612-1085
Mailing Address - Fax:801-337-1104
Practice Address - Street 1:1900 WASHINGTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6850
Practice Address - Country:US
Practice Address - Phone:801-612-1085
Practice Address - Fax:801-337-1104
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13739844-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor