Provider Demographics
NPI:1275734907
Name:GRANT CHIROPRACTIC LIFE CENTER, P.C.
Entity Type:Organization
Organization Name:GRANT CHIROPRACTIC LIFE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-786-9222
Mailing Address - Street 1:2510 W CHANDLER BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4919
Mailing Address - Country:US
Mailing Address - Phone:480-786-9222
Mailing Address - Fax:480-786-6997
Practice Address - Street 1:2510 W CHANDLER BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4919
Practice Address - Country:US
Practice Address - Phone:480-786-9222
Practice Address - Fax:480-786-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty