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General NPI Number Information
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NPI Number | 1205009412
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Entity Type | Organization
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Legal Business Name | EIGHTEEN95, PA
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 3500 WILLIAM D. TATE SUITE 175
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-421-4775
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Fax | 817-421-4303
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Provider Business Mailing Address
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Address Line | 3500 WILLIAM D. TATE SUITE 175
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-421-4775
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Fax | 817-421-4303
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEREDITH LYNN GRADY
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Credential | DC
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Telephone | 817-421-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9378
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License Number State | TX
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