MEDICARE: DR. MITCHELL MCLEAN GRANDI DC

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	DC15216	CA

General Provider Information

NPI Number	:	1760463277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL MCLEAN GRANDI DC

Provider Business Mailing Address
First Line	:	8499 OLD REDWOOD HWY
Second Line	:	STE 204
City	:	WINDSOR
State	:	CA
Zip	:	95492-8056
Country	:	US
Telephone Number	:	707-838-8400
Fax Number	:	707-838-9097

Provider Business Practice Location Address
First Line	:	8499 OLD REDWOOD HWY
Second Line	:	STE 204
City	:	WINDSOR
State	:	CA
Zip	:	95492-8056
Country	:	US
Telephone Number	:	707-838-8400
Fax Number	:	707-838-9097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/10/2011

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