MEDICARE: DR. GRANT T DAWSON 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	27-1240	OR

General Provider Information

NPI Number	:	1417991100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRANT T DAWSON D.C.

Provider Business Mailing Address
First Line	:	19767 SW 72ND AVE
Second Line	:	SUITE 103
City	:	TUALATIN
State	:	OR
Zip	:	97062-8354
Country	:	US
Telephone Number	:	503-620-6480
Fax Number	:	503-684-4598

Provider Business Practice Location Address
First Line	:	19767 SW 72ND AVE
Second Line	:	SUITE 103
City	:	TUALATIN
State	:	OR
Zip	:	97062-8354
Country	:	US
Telephone Number	:	503-620-6480
Fax Number	:	503-684-4598

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	01/30/2012

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