Provider Demographics
NPI:1023059755
Name:GRAND CHIROPRACTIC
Entity type:Organization
Organization Name:GRAND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:GRANDIZIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:856-467-3377
Mailing Address - Street 1:511 BECKETT RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1548
Mailing Address - Country:US
Mailing Address - Phone:856-467-3377
Mailing Address - Fax:856-467-3370
Practice Address - Street 1:511 BECKETT RD
Practice Address - Street 2:
Practice Address - City:LOGAN TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1548
Practice Address - Country:US
Practice Address - Phone:856-467-3377
Practice Address - Fax:856-467-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00623400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty