Provider Demographics
NPI:1568134781
Name:GRANT, GARRETT (DC)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
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 1:16766 BERNARDO CENTER DR STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2501
Mailing Address - Country:US
Mailing Address - Phone:858-248-6115
Mailing Address - Fax:
Practice Address - Street 1:16766 BERNARDO CENTER DR STE 112
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2501
Practice Address - Country:US
Practice Address - Phone:858-248-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor