MEDICARE: GRANGER CHIROPRACTIC AND FAMILY MEDICINE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1140	OH

General Provider Information

NPI Number	:	1700091394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANGER CHIROPRACTIC AND FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	1349 MCNAUGHTEN RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1678
Country	:	US
Telephone Number	:	614-864-3888
Fax Number	:	614-864-6668

Provider Business Practice Location Address
First Line	:	1349 MCNAUGHTEN RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1678
Country	:	US
Telephone Number	:	614-864-3888
Fax Number	:	614-864-6668

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN K GRANGER
Credential	:	DC
Telephone Number	:	614-864-3888

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	09/11/2012

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