MEDICARE: DAVID DANIEL GRANT D.C.

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	03514	MD
2	111N00000X	Chiropractor	2301009238	MI

General Provider Information

NPI Number	:	1356477897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DANIEL GRANT D.C.

Provider Business Mailing Address
First Line	:	262 KERBY RD
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3146
Country	:	US
Telephone Number	:	313-930-4347
Fax Number	:

Provider Business Practice Location Address
First Line	:	23610 VAN BORN RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2356
Country	:	US
Telephone Number	:	313-291-1060
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/15/2008

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