Provider Demographics
NPI:1124062633
Name:GRANONE, JOHN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GRANONE
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 1:23 E TARPON AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16541 POINTE VILLAGE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5258
Practice Address - Country:US
Practice Address - Phone:813-336-4461
Practice Address - Fax:813-336-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381861600Medicaid
FL647056OtherUNITED HEALTH CARE
FL89863OtherBCBS
FLU84897Medicare UPIN
FL89863OtherBCBS