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General NPI Number Information
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NPI Number | 1821233164
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Entity Type | Individual
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Provider Name | GRANT ALEXANDER REDSTONE D.C. FIAMA, PC
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Gender | Male
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 1750 105TH AVENUE NE
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City | BLAINE
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State | MN
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Zip | 55449
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Country | US
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Telephone | 763-780-0356
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 105TH AVENUE NE
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City | BLAINE
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State | MN
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Zip | 55449-4500
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Country | US
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Telephone | 763-780-0356
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2774307-1202
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License Number State | UT
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