Provider Demographics
NPI:1700091394
Name:GRANGER CHIROPRACTIC AND FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:GRANGER CHIROPRACTIC AND FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-864-3888
Mailing Address - Street 1:1349 MCNAUGHTEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-1678
Mailing Address - Country:US
Mailing Address - Phone:614-864-3888
Mailing Address - Fax:614-864-6668
Practice Address - Street 1:1349 MCNAUGHTEN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-1678
Practice Address - Country:US
Practice Address - Phone:614-864-3888
Practice Address - Fax:614-864-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX-ID
OHT48380Medicare UPIN
OH=========OtherTAX-ID