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General NPI Number Information
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NPI Number | 1245054683
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Entity Type | Organization
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Legal Business Name | GRANT CHIROPRACTIC & SPORTS REHAB, INC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 16766 BERNARDO CENTER DR STE 112
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City | SAN DIEGO
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State | CA
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Zip | 92128-2501
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Country | US
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Telephone | 858-248-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 16766 BERNARDO CENTER DR STE 112
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City | SAN DIEGO
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State | CA
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Zip | 92128-2501
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Country | US
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Telephone | 858-248-6115
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARRETT GRANT
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Credential | DC
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Telephone | 858-248-6115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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