NPI Code Detail JSON Logo

1962654160 NPI number — LISA BRADY GRANT DC

NPI Number: 1962654160
Health Care Provider/Practitioner: LISA BRADY GRANT DC

Information about “1962654160” NPI (LISA BRADY GRANT DC) exists in 1962654160 in HTML format HTML  |  1962654160 in plain Text format TXT  |  1962654160 in PDF (Portable Document Format) PDF  |  1962654160 in an XML format XML  formats.

NPI Number : 1962654160 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962654160",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRANT",
    "FirstName": "LISA",
    "MiddleName": "BRADY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1426",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILSON",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "83014-1426",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-739-0553",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "290 W. KELLY ST.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "83001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-739-0553",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/21/2008",
    "LastUpdateDate": "10/21/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "510",
        "LicenseNumberStateCode": "WY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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