Provider Demographics
NPI:1275800740
Name:GRAINGER, EVAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:SCOTT
Last Name:GRAINGER
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 1:205 HIGHWAY 17 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-8943
Mailing Address - Country:US
Mailing Address - Phone:843-663-3377
Mailing Address - Fax:843-280-2089
Practice Address - Street 1:205 HIGHWAY 17 N
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-8943
Practice Address - Country:US
Practice Address - Phone:843-663-3377
Practice Address - Fax:843-280-2089
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor