Provider Demographics
NPI:1710277579
Name:LEGRANT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LEGRANT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAPHET
Authorized Official - Middle Name:DIVAD
Authorized Official - Last Name:LEGANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-749-9809
Mailing Address - Street 1:403 MOUNT CROSS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5561
Mailing Address - Country:US
Mailing Address - Phone:434-799-2444
Mailing Address - Fax:336-235-4023
Practice Address - Street 1:403 MOUNT CROSS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5561
Practice Address - Country:US
Practice Address - Phone:434-799-2444
Practice Address - Fax:336-235-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556091111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty