Provider Demographics
NPI:1861950156
Name:GASPARD, GRANT (DC, ATC)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:GASPARD
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12977 N 40 DR STE 212
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8655
Mailing Address - Country:US
Mailing Address - Phone:217-415-5789
Mailing Address - Fax:
Practice Address - Street 1:12977 N 40 DR STE 212
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8655
Practice Address - Country:US
Practice Address - Phone:217-415-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023002895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty