Provider Demographics
NPI:1134342710
Name:GRANDVIEW MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GRANDVIEW MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KNICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:614-488-2225
Mailing Address - Street 1:1378 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2803
Mailing Address - Country:US
Mailing Address - Phone:614-488-2225
Mailing Address - Fax:614-488-2229
Practice Address - Street 1:1378 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2803
Practice Address - Country:US
Practice Address - Phone:614-488-2225
Practice Address - Fax:614-488-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty