MEDICARE: JASON WATSON GRANEY D C

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

General Provider Information

NPI Number	:	1255082830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON WATSON GRANEY D C

Provider Business Mailing Address
First Line	:	4690 NEBO DR
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5233
Country	:	US
Telephone Number	:	619-460-2224
Fax Number	:	619-460-2226

Provider Business Practice Location Address
First Line	:	4690 NEBO DR
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5233
Country	:	US
Telephone Number	:	619-460-2224
Fax Number	:	619-460-2226

Authorized Official
Title or Position	:	OWNER
Name	:	JASON W GRANEY
Credential	:
Telephone Number	:	619-460-2224

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	03/15/2022

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