Provider Demographics
NPI:1760981690
Name:SMITH, GRANT EDWARD (D C)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13925 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5118
Mailing Address - Country:US
Mailing Address - Phone:361-767-3300
Mailing Address - Fax:361-767-3320
Practice Address - Street 1:13925 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5118
Practice Address - Country:US
Practice Address - Phone:361-767-3300
Practice Address - Fax:361-767-3320
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor