Provider Demographics
NPI:1154637197
Name:TODD N. GRANT DC PC
Entity Type:Organization
Organization Name:TODD N. GRANT DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:NASH
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-546-2273
Mailing Address - Street 1:280 W 200 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2183
Mailing Address - Country:US
Mailing Address - Phone:801-546-2273
Mailing Address - Fax:801-546-4585
Practice Address - Street 1:280 W 200 N
Practice Address - Street 2:SUITE A
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2183
Practice Address - Country:US
Practice Address - Phone:801-546-2273
Practice Address - Fax:801-546-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1761081202261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056007Medicare UPIN
UTU25158Medicare UPIN