Healthcare Provider Details

I. General information

NPI: 1821058751
Provider Name (Legal Business Name): EDWARD GRANAT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E DUNDEE RD
WHEELING IL
60090-3192
US

IV. Provider business mailing address

1638 S AMARIAS DR
ROUND LAKE IL
60073-4281
US

V. Phone/Fax

Practice location:
  • Phone: 847-243-2110
  • Fax: 847-243-2118
Mailing address:
  • Phone: 847-243-2110
  • Fax: 847-243-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: