Provider Demographics
NPI:1740734953
Name:FULL MOTION CHIROPRACTIC AND REHABILITATION,
Entity Type:Organization
Organization Name:FULL MOTION CHIROPRACTIC AND REHABILITATION,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-901-6844
Mailing Address - Street 1:1220 N 500 W STE 101
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1107
Mailing Address - Country:US
Mailing Address - Phone:801-901-6844
Mailing Address - Fax:
Practice Address - Street 1:1220 N 500 W STE 101
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1107
Practice Address - Country:US
Practice Address - Phone:801-901-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT72468741202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty