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General NPI Number Information
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NPI Number | 1871483289
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Entity Type | Organization
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Legal Business Name | 100 CHIROPRACTIC GRANT SE INC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1217 SAN ELIJO RD S STE 101
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City | SAN MARCOS
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State | CA
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Zip | 92078-1172
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Country | US
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Telephone | 209-498-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 20551 N PIMA RD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-9154
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE GRANT
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Credential | DC
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Telephone | 858-524-1091
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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 |
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License Number State |
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