Provider Demographics
NPI:1225363039
Name:SANDERS, GRANT DAVID (DC, PHD, CSCS)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:DAVID
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DC, PHD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 CHAGRIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-1129
Mailing Address - Country:US
Mailing Address - Phone:440-600-7407
Mailing Address - Fax:440-600-7417
Practice Address - Street 1:7209 CHAGRIN RD STE A
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-1129
Practice Address - Country:US
Practice Address - Phone:440-600-7407
Practice Address - Fax:440-600-7417
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor