Provider Demographics
NPI:1477787174
Name:ANDERSON, GRANT MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:MICHAEL
Last Name:ANDERSON
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 1:1 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-3714
Mailing Address - Country:US
Mailing Address - Phone:605-882-4252
Mailing Address - Fax:605-886-5589
Practice Address - Street 1:1 5TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3714
Practice Address - Country:US
Practice Address - Phone:605-882-4252
Practice Address - Fax:605-886-5589
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor