Provider Demographics
NPI:1033235742
Name:BILLY D. GRANT, D.C., PSC
Entity Type:Organization
Organization Name:BILLY D. GRANT, D.C., PSC
Other - Org Name:HEALTHSOURCE/BILLY D. GRANT, D.C., PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-885-2351
Mailing Address - Street 1:1222 SKYLINE DRIVE
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-885-2366
Mailing Address - Fax:270-885-2356
Practice Address - Street 1:1222 SKYLINE DR STE A&B
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4968
Practice Address - Country:US
Practice Address - Phone:270-885-2366
Practice Address - Fax:270-885-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000215455OtherBLUE CROSS BLUE SHIELD
KY85900165Medicaid