Provider Demographics
NPI:1295464725
Name:EICHSTADT, GRANT MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:MICHAEL
Last Name:EICHSTADT
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 1:5007 SOUTHPARK DR STE 130
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7739
Mailing Address - Country:US
Mailing Address - Phone:919-572-2312
Mailing Address - Fax:919-572-2437
Practice Address - Street 1:5007 SOUTHPARK DR STE 130
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7739
Practice Address - Country:US
Practice Address - Phone:919-572-2312
Practice Address - Fax:919-572-2437
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty