Healthcare Provider Details

I. General information

NPI: 1528257953
Provider Name (Legal Business Name): JOHN LAWRENCE GRANT SR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 MT. HERMON ROAD
SALISBURY MD
21804-5300
US

IV. Provider business mailing address

1319 MT. HERMON ROAD
SALISBURY MD
21804-5300
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-1500
  • Fax: 410-548-1614
Mailing address:
  • Phone: 410-548-1500
  • Fax: 410-548-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS01397
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberS01397
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: