Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 645 | WV |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 762 | OH |
NPI | 1679634695 |
---|---|
Provider Name | Dr. James J. Graneto |
First Address | Youngstown, OH 44512-7317 |
Second Address | Youngstown, OH 44512-7317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0131208-000 | (05) | WV |
0434891 | (05) | OH |
T47121 | (02) | OH |