Provider Demographics
NPI:1922171198
Name:STODDARD, GRANT FIELDING (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:FIELDING
Last Name:STODDARD
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 1:2704 SOUTHERN BLVD SE
Mailing Address - Street 2:STE. #3
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3748
Mailing Address - Country:US
Mailing Address - Phone:505-896-1300
Mailing Address - Fax:505-896-6833
Practice Address - Street 1:2704 SOUTHERN BLVD SE
Practice Address - Street 2:STE. #3
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3748
Practice Address - Country:US
Practice Address - Phone:505-896-1300
Practice Address - Fax:505-896-6833
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor