Individual
LARISA GRANOVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
842 RED LION RD, #5, PHILADELPHIA, PA 19115-1475
(215) 464-0404
(215) 464-0683
Mailing address
842 RED LION RD, #5, PHILADELPHIA, PA 19115-1475
(215) 464-0404
(215) 464-0683
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC-006295-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015288270001
—
PA
Enumeration date
09/21/2005
Last updated
07/08/2007
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