Provider Demographics
NPI:1154302875
Name:HOFFMAN, GRANT D (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:D
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 BRUNDAGE LANE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2702
Mailing Address - Country:US
Mailing Address - Phone:661-873-4742
Mailing Address - Fax:661-873-4734
Practice Address - Street 1:2140 BRUNDAGE LANE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2702
Practice Address - Country:US
Practice Address - Phone:661-873-4742
Practice Address - Fax:661-873-4734
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0255430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92104Medicare UPIN
CADC0255430Medicare ID - Type Unspecified