Healthcare Provider Details

I. General information

NPI: 1588691570
Provider Name (Legal Business Name): JAY PAUL GRANT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WEST MAIN STREET
AMERICAN FORK UT
84003-2227
US

IV. Provider business mailing address

201W MAIN ST
AMERICAN FORK UT
84003-2227
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-6868
  • Fax: 801-763-1985
Mailing address:
  • Phone: 801-756-6868
  • Fax: 801-763-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number901758971202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: