=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215003785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRI LYNN GRANT D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 LAFAYETTE ROAD SUITE301
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-380-2026
-----------------------------------------------------
Fax | 603-319-4604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 FILLMORE RD
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-5812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-380-2026
-----------------------------------------------------
Fax | 603-319-4604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 769-0806
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------