Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 15945 | OR |
NPI | 1003045832 |
---|---|
Provider Name | Nicole Marie Granger |
First Address | Gaston, OR 97119-7721 |
Second Address | Vancouver, WA 98686-2698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 12/03/2013 |