MEDICARE: GRANT ANDRES 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	8062	AZ

General Provider Information

NPI Number	:	1831606649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT ANDRES DC

Provider Business Mailing Address
First Line	:	17100 E SHEA BLVD STE 320
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-6654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17100 E SHEA BLVD STE 320
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-6654
Country	:	US
Telephone Number	:	480-816-8300
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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