Provider Demographics
NPI:1538292446
Name:GRANT, ROBERT EARL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EARL
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 1:3105 TWINFALLS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3329
Mailing Address - Country:US
Mailing Address - Phone:972-596-6388
Mailing Address - Fax:
Practice Address - Street 1:320 REGAL ROW
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5200
Practice Address - Country:US
Practice Address - Phone:972-557-7000
Practice Address - Fax:972-557-7001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605586Medicare ID - Type Unspecified
TXG39950Medicare UPIN