Provider Demographics
NPI:1225210420
Name:GRANT CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:GRANT CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-384-3271
Mailing Address - Street 1:908 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1036
Mailing Address - Country:US
Mailing Address - Phone:270-384-3271
Mailing Address - Fax:270-384-3271
Practice Address - Street 1:908 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1036
Practice Address - Country:US
Practice Address - Phone:270-384-3271
Practice Address - Fax:270-384-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4303261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000330968OtherBLUE CROSS AND BLUE SHIEL
KY85900413Medicaid
KY000000330968OtherBLUE CROSS AND BLUE SHIEL