Provider Demographics
NPI:1699068023
Name:GRANITE FAMILY CHIROPRACTIC AND NUTRITION
Entity type:Organization
Organization Name:GRANITE FAMILY CHIROPRACTIC AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-467-0088
Mailing Address - Street 1:333 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4530
Mailing Address - Country:US
Mailing Address - Phone:781-467-0088
Mailing Address - Fax:
Practice Address - Street 1:333 ELM ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4530
Practice Address - Country:US
Practice Address - Phone:781-467-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty