Provider Demographics
NPI:1154702058
Name:JEANNE M GRANT CHIROPRACTIC CORP
Entity type:Organization
Organization Name:JEANNE M GRANT CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-562-6860
Mailing Address - Street 1:9307 CARLTON HILLS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2572
Mailing Address - Country:US
Mailing Address - Phone:619-562-6860
Mailing Address - Fax:619-562-9871
Practice Address - Street 1:9307 CARLTON HILLS BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2572
Practice Address - Country:US
Practice Address - Phone:619-562-6860
Practice Address - Fax:619-562-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23262AMedicare UPIN