Provider Demographics
NPI:1013038223
Name:GRANT, CAROL C (DC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:C
Last Name:GRANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MERIDEN-WATERBURY TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MILLDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06467-0792
Mailing Address - Country:US
Mailing Address - Phone:860-620-9523
Mailing Address - Fax:860-620-9628
Practice Address - Street 1:1601 MERIDEN-WATERBURY TPK
Practice Address - Street 2:
Practice Address - City:MILLDALE
Practice Address - State:CT
Practice Address - Zip Code:06467-0792
Practice Address - Country:US
Practice Address - Phone:860-620-9523
Practice Address - Fax:860-620-9628
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT587111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000587CT04OtherANTHEM
CT350000932Medicare ID - Type Unspecified
CT21997Medicare UPIN