Provider Demographics
NPI:1700976446
Name:GRANT, ANDREW D (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:GRANT
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:PO BOX 1235
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752
Mailing Address - Country:US
Mailing Address - Phone:828-652-7746
Mailing Address - Fax:828-652-7746
Practice Address - Street 1:1135 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752
Practice Address - Country:US
Practice Address - Phone:828-652-7746
Practice Address - Fax:828-652-7746
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890844GMedicaid
NC890844GMedicaid
T55024Medicare UPIN