MEDICARE: DR. CIARAN O. GRANT DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X011053-1	NY

General Provider Information

NPI Number	:	1073571808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CIARAN O. GRANT DC

Provider Business Mailing Address
First Line	:	415 W. 57TH ST
Second Line	:	SUITE B/C
City	:	NEW YORK
State	:	NY
Zip	:	10019-1753
Country	:	US
Telephone Number	:	914-714-0336
Fax Number	:	212-246-1088

Provider Business Practice Location Address
First Line	:	415 W 57TH ST
Second Line	:	SUITE B/C
City	:	NEW YORK
State	:	NY
Zip	:	10019-1752
Country	:	US
Telephone Number	:	914-714-0336
Fax Number	:	212-246-1088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	12/02/2010

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