Provider Demographics
NPI:1992769046
Name:GRANT, THOMAS EARL JR (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EARL
Last Name:GRANT
Suffix:JR
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 1:1390 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:NAUVOO
Mailing Address - State:IL
Mailing Address - Zip Code:62354-2037
Mailing Address - Country:US
Mailing Address - Phone:801-376-9596
Mailing Address - Fax:
Practice Address - Street 1:1390 MULHOLLAND ST
Practice Address - Street 2:
Practice Address - City:NAUVOO
Practice Address - State:IL
Practice Address - Zip Code:62354-1010
Practice Address - Country:US
Practice Address - Phone:172-250-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6715760-1202111N00000X, 111NN0400X, 111NS0005X, 111NX0800X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic