Provider Demographics
NPI:1215131628
Name:VARRIAL GRANT, CHANTELLE R (DC)
Entity type:Individual
Prefix:DR
First Name:CHANTELLE
Middle Name:R
Last Name:VARRIAL GRANT
Suffix:
Gender:F
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07802-0468
Mailing Address - Country:US
Mailing Address - Phone:973-328-2588
Mailing Address - Fax:
Practice Address - Street 1:6-16 E BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4664
Practice Address - Country:US
Practice Address - Phone:973-328-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020381Medicare PIN
NJ672417Medicare UPIN