Provider Demographics
NPI:1588691570
Name:GRANT, JAY PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:PAUL
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 1:201W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2227
Mailing Address - Country:US
Mailing Address - Phone:801-756-6868
Mailing Address - Fax:801-763-1985
Practice Address - Street 1:201 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2227
Practice Address - Country:US
Practice Address - Phone:801-756-6868
Practice Address - Fax:801-763-1985
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT901758971202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5292851477001OtherBCBS
UT53752OtherU OF W HEALTH PLAN
UT23516OtherPEHP
UT870395551GR1OtherED MUTUAL
UT10463OtherATTIUS
U39956Medicare UPIN
UT10463OtherATTIUS