Provider Demographics
NPI:1275943599
Name:SANDERS, GRANT STEVEN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:STEVEN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 STATE ROUTE 662 W
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8845
Mailing Address - Country:US
Mailing Address - Phone:812-490-9800
Mailing Address - Fax:812-490-9801
Practice Address - Street 1:10622 STATE ROUTE 662 W
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8845
Practice Address - Country:US
Practice Address - Phone:812-490-9800
Practice Address - Fax:812-490-9801
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81000155A171100000X
IN08002773A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist