Provider Demographics
NPI:1386963312
Name:GRANT, LEE MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:MICHAEL
Last Name:GRANT
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 1:615 N COMMERCE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3942
Mailing Address - Country:US
Mailing Address - Phone:580-222-6777
Mailing Address - Fax:
Practice Address - Street 1:615 N COMMERCE ST
Practice Address - Street 2:SUITE E
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3942
Practice Address - Country:US
Practice Address - Phone:580-222-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor