Provider Demographics
NPI:1801071527
Name:GRANOVSKY, GRAIG V (DC)
Entity type:Individual
Prefix:DR
First Name:GRAIG
Middle Name:V
Last Name:GRANOVSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GRAIG
Other - Middle Name:V
Other - Last Name:GRANOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1684 E 18TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1249
Mailing Address - Country:US
Mailing Address - Phone:718-339-3030
Mailing Address - Fax:
Practice Address - Street 1:1684 E 18TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1249
Practice Address - Country:US
Practice Address - Phone:718-339-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011465111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX9776XWRP1Medicare PIN