MEDICARE: GRANT DAVID SANDERS DC, PHD, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4554	OH

General Provider Information

NPI Number	:	1225363039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT DAVID SANDERS DC, PHD, CSCS

Provider Business Mailing Address
First Line	:	7209 CHAGRIN RD STE A
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-1129
Country	:	US
Telephone Number	:	440-600-7407
Fax Number	:	440-600-7417

Provider Business Practice Location Address
First Line	:	7209 CHAGRIN RD STE A
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-1129
Country	:	US
Telephone Number	:	440-600-7407
Fax Number	:	440-600-7417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	04/11/2018

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