Physician Compare National (NPI:1104849793)

HEALTHCARE PROVIDER: GORDON HARRIMAN GRANNIS D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104849793
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355442203
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070723000750
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRANNIS
	Individual professional last name
Provider First Name	GORDON
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PALMER COLLEGE CHIROPRACTIC - DAVENPORT
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GORDON H GRANNIS, D.C., A CHIROPRACTIC PROFESSIONAL CORPORATION
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7810098761
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	24541 PACIFIC PARK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 290
	Group Practice or individual's line 2 address
City	ALISO VIEJO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	926563058
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9494488599
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M