Provider Demographics
NPI:1902808504
Name:GRANDIZIO, FRANCIS VERNON JR (DC)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:VERNON
Last Name:GRANDIZIO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4515 PENNELL RD
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-3020
Mailing Address - Country:US
Mailing Address - Phone:610-497-1928
Mailing Address - Fax:610-497-6755
Practice Address - Street 1:4515 PENNELL RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-3020
Practice Address - Country:US
Practice Address - Phone:610-497-1928
Practice Address - Fax:610-497-6755
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004946L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA159190Medicare ID - Type Unspecified
PAU51873Medicare UPIN