MEDICARE: DR. SHANTE GRIGGS PHARMD, DN

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	133N00000X	Nutritionist	181000392	IL
2	133NN1002X	Nutrition Education Nutritionist
3	172P00000X	Naprapath	01013	NM
4	174400000X	Specialist	181000392	IL
5	174H00000X	Health Educator
6	183500000X	Pharmacist	051292165	IL
7	1835N1003X	Nutrition Support Pharmacist	051292165	IL
8	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051292165	IL
9	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	01013	NM
10	208100000X	Physical Medicine & Rehabilitation Physician	01013	NM
11	208100000X	Physical Medicine & Rehabilitation Physician	181000392	IL
12	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	181000392	IL
13	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	181000392	IL
14	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	181000392	IL
15	172P00000X	Naprapath	181000392	IL

General Provider Information

NPI Number	:	1932413077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTE GRIGGS PHARMD, DN

Provider Business Mailing Address
First Line	:	320 E 21ST ST UNIT 405
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4979
Country	:	US
Telephone Number	:	312-872-7232
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4001
Country	:	US
Telephone Number	:	773-282-2686
Fax Number	:	773-282-2688

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

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	01/25/2023

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