Provider Demographics
NPI:1417991100
Name:DAWSON, GRANT T (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:T
Last Name:DAWSON
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 1:19767 SW 72ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8354
Mailing Address - Country:US
Mailing Address - Phone:503-620-6480
Mailing Address - Fax:503-684-4598
Practice Address - Street 1:19767 SW 72ND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8354
Practice Address - Country:US
Practice Address - Phone:503-620-6480
Practice Address - Fax:503-684-4598
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGBRSMedicare ID - Type Unspecified
ORT67558Medicare UPIN