Healthcare Provider Details

I. General information

NPI: 1326938721
Provider Name (Legal Business Name): 100 CHIROPRACTIC GRANT LN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30301 GOLDEN LANTERN STE C
LAGUNA NIGUEL CA
92677-5990
US

IV. Provider business mailing address

20551 N PIMA RD STE 100
SCOTTSDALE AZ
85255-9154
US

V. Phone/Fax

Practice location:
  • Phone: 949-994-9905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE GRANT
Title or Position: OWNER
Credential:
Phone: 858-524-1091