Provider Demographics
NPI:1568111029
Name:GRANT, KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
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 1:320 SINGLETON BLVD APT 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-4117
Mailing Address - Country:US
Mailing Address - Phone:972-807-2310
Mailing Address - Fax:
Practice Address - Street 1:320 SINGLETON BLVD APT 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-4117
Practice Address - Country:US
Practice Address - Phone:972-807-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor