Provider Demographics
NPI:1336406487
Name:GRANT CHIROPRACTIC OF BLUE RIDGE, PC
Entity type:Organization
Organization Name:GRANT CHIROPRACTIC OF BLUE RIDGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-632-6574
Mailing Address - Street 1:2710 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4510
Mailing Address - Country:US
Mailing Address - Phone:706-632-6574
Mailing Address - Fax:706-632-6527
Practice Address - Street 1:2710 E FIRST ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4510
Practice Address - Country:US
Practice Address - Phone:706-632-6574
Practice Address - Fax:706-632-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty