Provider Demographics
NPI:1821233164
Name:REDSTONE, GRANT ALEXANDER (DC FIAMA, PC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:ALEXANDER
Last Name:REDSTONE
Suffix:
Gender:M
Credentials:DC FIAMA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 105TH AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4500
Mailing Address - Country:US
Mailing Address - Phone:763-780-0356
Mailing Address - Fax:
Practice Address - Street 1:1750 105TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449
Practice Address - Country:US
Practice Address - Phone:763-780-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2774307-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor