Provider Demographics
NPI:1770677312
Name:GRADY, MEREDITH LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:LYNN
Last Name:GRADY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 WILLIAMS D. TATE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-421-4775
Mailing Address - Fax:817-421-4303
Practice Address - Street 1:3500 WILLIAMS D. TATE
Practice Address - Street 2:SUITE 175
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-421-4775
Practice Address - Fax:817-421-4303
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13-4206042OtherFAMILY HEALTH AMERICA
TX2061868Medicare UPIN
TX13-4206042OtherFAMILY HEALTH AMERICA
TX608860Medicare UPIN
TX609793Medicare ID - Type UnspecifiedNON-PARTICIPATING PROVIDE
TXP71617Medicare UPIN