Provider Demographics
NPI:1700855152
Name:SEXTON, GRANT JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:JOSEPH
Last Name:SEXTON
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 1:779 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3948
Mailing Address - Country:US
Mailing Address - Phone:215-322-9989
Mailing Address - Fax:215-322-0948
Practice Address - Street 1:779 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3948
Practice Address - Country:US
Practice Address - Phone:215-322-9989
Practice Address - Fax:215-322-0948
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007556L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028368R9BMedicare ID - Type Unspecified
PAU75646Medicare UPIN