Provider Demographics
NPI:1164489779
Name:GRANDY, BOB R (DC)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:R
Last Name:GRANDY
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 1:653 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATESBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29006-1810
Mailing Address - Country:US
Mailing Address - Phone:803-532-3180
Mailing Address - Fax:803-532-3180
Practice Address - Street 1:653 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-1810
Practice Address - Country:US
Practice Address - Phone:803-532-3180
Practice Address - Fax:803-532-3180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor