Provider Demographics
NPI:1619982071
Name:SUSSEX-GRANT, ERICA L (DC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:L
Last Name:SUSSEX-GRANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:SUSSEX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1525 E SPRING ST STE G
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4369
Mailing Address - Country:US
Mailing Address - Phone:931-615-1320
Mailing Address - Fax:
Practice Address - Street 1:1525 E SPRING ST STE G
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4369
Practice Address - Country:US
Practice Address - Phone:931-651-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1589111N00000X
TN3558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMV05785Medicare UPIN