Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3012 | OH |
NPI | 1003857608 |
---|---|
Provider Name | Andrew Jason Granger |
First Address | Galena, OH 43021-9756 |
Second Address | Columbus, OH 43240-2022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000299311 | ANTHEM BCBS (01) | OH |
2180045 | (05) | OH |
U81474 | (02) | OH |