=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336406487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANT CHIROPRACTIC OF BLUE RIDGE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2012
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2710 E FIRST ST
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-632-6574
-----------------------------------------------------
Fax | 706-632-6527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2710 E FIRST ST
-----------------------------------------------------
City | BLUE RIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30513-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-632-6574
-----------------------------------------------------
Fax | 706-632-6527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JOHN ROBERT GRANT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 706-632-6574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 003032
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------