Provider Demographics
NPI:1982693933
Name:GRANLUND, LAWRENCE JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:GRANLUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 STONE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1667
Mailing Address - Country:US
Mailing Address - Phone:703-815-0700
Mailing Address - Fax:703-815-0701
Practice Address - Street 1:5675 STONE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1667
Practice Address - Country:US
Practice Address - Phone:703-815-0700
Practice Address - Fax:703-815-0701
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA093770OtherPROVIDER NUMBER-ANTHEM
VA093770OtherPROVIDER NUMBER-ANTHEM