Provider Demographics
NPI:1386748564
Name:HOWARD, GANIM (DC)
Entity type:Individual
Prefix:
First Name:GANIM
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2539
Mailing Address - Country:US
Mailing Address - Phone:304-925-1697
Mailing Address - Fax:304-925-1698
Practice Address - Street 1:4216 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2539
Practice Address - Country:US
Practice Address - Phone:304-925-1697
Practice Address - Fax:304-925-1698
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2202010000Medicaid
WV4042281Medicare PIN
U84714Medicare UPIN