Healthcare Provider Details

I. General information

NPI: 1801216502
Provider Name (Legal Business Name): NICHOLAS GRANT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 1ST ST STE 101
SAN FRANCISCO CA
94105-4608
US

IV. Provider business mailing address

PO BOX 1848
NOVATO CA
94948-1848
US

V. Phone/Fax

Practice location:
  • Phone: 415-495-2225
  • Fax: 415-495-2228
Mailing address:
  • Phone: 415-892-7560
  • Fax: 415-892-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: