Healthcare Provider Details

I. General information

NPI: 1932511656
Provider Name (Legal Business Name): SHEALYN GRANT LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13712 NE 20TH AVE
VANCOUVER WA
98686-2698
US

IV. Provider business mailing address

13712 NE 20TH AVE
VANCOUVER WA
98686-2698
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-5944
  • Fax: 360-574-6430
Mailing address:
  • Phone: 360-574-5944
  • Fax: 360-574-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number91-2087673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: