Provider Demographics
NPI:1134446404
Name:MCDONOUGH, GRANT AUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:AUSTIN
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 S CHERRY ST
Mailing Address - Street 2:STE. 1105
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1702
Mailing Address - Country:US
Mailing Address - Phone:720-941-5000
Mailing Address - Fax:303-394-2587
Practice Address - Street 1:600 S CHERRY ST
Practice Address - Street 2:STE. 1105
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1702
Practice Address - Country:US
Practice Address - Phone:720-941-5000
Practice Address - Fax:303-394-2587
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR6520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor