Provider Demographics
NPI:1801216502
Name:GRANT, NICHOLAS (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GRANT
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:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-1848
Mailing Address - Country:US
Mailing Address - Phone:415-892-7560
Mailing Address - Fax:415-892-7509
Practice Address - Street 1:246 1ST ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-4608
Practice Address - Country:US
Practice Address - Phone:415-495-2225
Practice Address - Fax:415-495-2228
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor