Provider Demographics
NPI:1417915463
Name:SHAPIRO, GRANT (DC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:SHAPIRO
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 1:333 N DOBSON RD STE 124
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:602-908-3815
Mailing Address - Fax:480-630-8159
Practice Address - Street 1:333 N DOBSON RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:602-908-3815
Practice Address - Fax:480-630-1859
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ502333Medicaid
AZ502333Medicaid
AZZ110069Medicare PIN
AZZ60551Medicare ID - Type UnspecifiedMEDICARE