Provider Demographics
NPI:1588611933
Name:LEGRANT, JAPHET (DC)
Entity Type:Individual
Prefix:DR
First Name:JAPHET
Middle Name:
Last Name:LEGRANT
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 1:441-G PINEY FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4154
Mailing Address - Country:US
Mailing Address - Phone:434-793-0700
Mailing Address - Fax:434-793-9315
Practice Address - Street 1:45 MARKETPLACE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6516
Practice Address - Country:US
Practice Address - Phone:540-483-3678
Practice Address - Fax:540-783-3820
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2963085OtherCIGNA PROVIDER ID
VA103264OtherBLUE CROSS PROVIDER NUMBE
VA2093091OtherFIRST HEALTH MAILHANDLERS
VA642186OtherAMERICAN CHIROPRACTIC ID
VA000385OtherASHN HEALTHKEEPERS ID
VA190000654Medicare ID - Type Unspecified