Healthcare Provider Details

I. General information

NPI: 1487840054
Provider Name (Legal Business Name): GRANT THOMAS ROMINE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14747 OAK RD BUILDING 3 SUITE 300
CARMEL IN
46033-8101
US

IV. Provider business mailing address

14747 OAK RD BUILDING 3 SUITE 300
CARMEL IN
46033-8101
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-1414
  • Fax: 317-818-1014
Mailing address:
  • Phone: 317-818-1414
  • Fax: 317-818-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: