Provider Demographics
NPI:1629395256
Name:SEBASTIANO, GRANT L (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:L
Last Name:SEBASTIANO
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 1:1032A KINLEY RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9632
Mailing Address - Country:US
Mailing Address - Phone:803-732-6635
Mailing Address - Fax:803-461-0655
Practice Address - Street 1:1032A KINLEY RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9632
Practice Address - Country:US
Practice Address - Phone:803-732-6635
Practice Address - Fax:803-461-0655
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3576111N00000X
GACHIR008651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor