Provider Demographics
NPI:1164874665
Name:VLASIN, GRANT (DC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:VLASIN
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-0096
Mailing Address - Country:US
Mailing Address - Phone:402-803-1002
Mailing Address - Fax:402-803-1052
Practice Address - Street 1:220 E 13TH ST
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2212
Practice Address - Country:US
Practice Address - Phone:402-826-5151
Practice Address - Fax:402-803-1052
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor