Healthcare Provider Details

I. General information

NPI: 1245054683
Provider Name (Legal Business Name): GRANT CHIROPRACTIC & SPORTS REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16766 BERNARDO CENTER DR STE 112
SAN DIEGO CA
92128-2501
US

IV. Provider business mailing address

16766 BERNARDO CENTER DR STE 112
SAN DIEGO CA
92128-2501
US

V. Phone/Fax

Practice location:
  • Phone: 858-248-6115
  • Fax:
Mailing address:
  • Phone: 858-248-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: GARRETT GRANT
Title or Position: PRESIDENT
Credential: DC
Phone: 858-248-6115