Provider Demographics
NPI:1063581023
Name:GRANT, JOSHUA ADAM (LIC AC DIPL AC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ADAM
Last Name:GRANT
Suffix:
Gender:M
Credentials:LIC AC DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-2420
Mailing Address - Country:US
Mailing Address - Phone:508-533-1234
Mailing Address - Fax:
Practice Address - Street 1:16 CAUSEWAY ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-2420
Practice Address - Country:US
Practice Address - Phone:508-533-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist