MEDICARE: JAVIROUS DEVONTAY GRANT

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	2854	AL

General Provider Information

NPI Number	:	1881435113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIROUS DEVONTAY GRANT

Provider Business Mailing Address
First Line	:	3164 PARTRIDGE RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-3022
Country	:	US
Telephone Number	:	334-221-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	7244 HALCYON PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7717
Country	:	US
Telephone Number	:	334-401-2361
Fax Number	:

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

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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Directions to “ JAVIROUS DEVONTAY GRANT ” Practice Location

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