Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH5620 | FL |
Y | 111NN0400X | Neurology | CH5620 | FL |
NPI | 1881704377 |
---|---|
Provider Name | Dr. Jonathan Gralnick |
First Address | Plantation, FL 33317-2911 |
Second Address | Plantation, FL 33317-2911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380177200 | (05) | FL |
U24264 | (02) | FL |