Provider Demographics
NPI:1598859605
Name:GRANT, PAMELA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JO
Last Name:GRANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:JO
Other - Last Name:GEHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:585 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1317
Mailing Address - Country:US
Mailing Address - Phone:317-219-0354
Mailing Address - Fax:317-219-3083
Practice Address - Street 1:585 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1317
Practice Address - Country:US
Practice Address - Phone:317-219-0354
Practice Address - Fax:317-219-3083
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002113A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN331140672-01OtherSAGAMORE
IN703858OtherUNITED HEALTH CARE
IN200838160 AMedicaid
IN000000504008OtherANTHEM BC/BS
IN331140672-01OtherSAGAMORE