Healthcare Provider Details

I. General information

NPI: 1295805208
Provider Name (Legal Business Name): GRANT FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SHERIDAN RD
NOBLESVILLE IN
46060-1317
US

IV. Provider business mailing address

585 SHERIDAN RD
NOBLESVILLE IN
46060-1317
US

V. Phone/Fax

Practice location:
  • Phone: 317-219-0354
  • Fax: 317-219-3083
Mailing address:
  • Phone: 317-219-0354
  • Fax: 317-219-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002113A
License Number StateIN

VIII. Authorized Official

Name: DR. PAMELA JO GRANT
Title or Position: OWNER
Credential: D.C.
Phone: 317-219-0354