Provider Demographics
NPI:1780769760
Name:GRANGER, KEVIN KING (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KING
Last Name:GRANGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:80 ROGERS ST
Mailing Address - Street 2:UNIT 8 D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5296
Mailing Address - Country:US
Mailing Address - Phone:727-248-0930
Mailing Address - Fax:866-245-2270
Practice Address - Street 1:2288 DREW ST
Practice Address - Street 2:SUITE E
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3307
Practice Address - Country:US
Practice Address - Phone:727-248-0930
Practice Address - Fax:866-245-2270
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH1140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0581632Medicare PIN