Provider Demographics
NPI:1528257953
Name:GRANT, JOHN LAWRENCE SR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:GRANT
Suffix:SR
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 1:1319 MT. HERMON ROAD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5300
Mailing Address - Country:US
Mailing Address - Phone:410-548-1500
Mailing Address - Fax:410-548-1614
Practice Address - Street 1:1319 MT. HERMON ROAD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5300
Practice Address - Country:US
Practice Address - Phone:410-548-1500
Practice Address - Fax:410-548-1614
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01397225100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist