Provider Demographics
NPI:1508041815
Name:GRANT, LYNDA S (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:S
Last Name:GRANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 MORRO RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3923
Mailing Address - Country:US
Mailing Address - Phone:805-466-1600
Mailing Address - Fax:
Practice Address - Street 1:8935 MORRO RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3923
Practice Address - Country:US
Practice Address - Phone:805-466-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU33684OtherUPIN
CAU33684OtherUPIN