Provider Demographics
NPI:1386735124
Name:GRANOZIO, VANESSA (DC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:GRANOZIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3251
Mailing Address - Country:US
Mailing Address - Phone:973-450-0086
Mailing Address - Fax:973-450-0086
Practice Address - Street 1:392 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3251
Practice Address - Country:US
Practice Address - Phone:973-450-0086
Practice Address - Fax:973-450-0086
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00291500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GR452146Medicare ID - Type Unspecified