Provider Demographics
NPI:1619961307
Name:GRANT, JEANNE M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 CARLTON HILLS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2572
Mailing Address - Country:US
Mailing Address - Phone:619-562-6860
Mailing Address - Fax:619-562-9871
Practice Address - Street 1:9307 CARLTON HILLS BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2572
Practice Address - Country:US
Practice Address - Phone:619-562-6860
Practice Address - Fax:619-562-9871
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2023-01-10
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CADC23263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU53080Medicare UPIN
CADC23263AMedicare ID - Type Unspecified