Provider Demographics
NPI:1356477897
Name:GRANT, DAVID DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DANIEL
Last Name:GRANT
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 1:262 KERBY RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3146
Mailing Address - Country:US
Mailing Address - Phone:313-930-4347
Mailing Address - Fax:
Practice Address - Street 1:23610 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2356
Practice Address - Country:US
Practice Address - Phone:313-291-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03514111N00000X
MI2301009238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor