Provider Demographics
NPI:1588630917
Name:WRIGHT, GRANT ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ROBERT
Last Name:WRIGHT
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 1:2022 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-2934
Mailing Address - Country:US
Mailing Address - Phone:336-724-0597
Mailing Address - Fax:336-724-3753
Practice Address - Street 1:2022 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2934
Practice Address - Country:US
Practice Address - Phone:336-724-0597
Practice Address - Fax:336-724-3753
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8280OtherPARTNERS
NC330555OtherAMERICAN CHIROPRACTIC NET
NC08942OtherBLUE CROSS BLUE SHIELD
NC8908942Medicaid
NC330555OtherAMERICAN CHIROPRACTIC NET
NC8280OtherPARTNERS