Provider Demographics
NPI:1013003631
Name:GRANT, ANTHONY WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:WAYNE
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 1:908 RUSSELL ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728
Mailing Address - Country:US
Mailing Address - Phone:270-384-3270
Mailing Address - Fax:270-384-3271
Practice Address - Street 1:908 RUSSELL ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728
Practice Address - Country:US
Practice Address - Phone:270-384-3270
Practice Address - Fax:270-384-3271
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000330968OtherBLUE CROSS PIN
KY85900413Medicaid
KY000000330968OtherBLUE CROSS PIN
KYU57929Medicare UPIN