Provider Demographics
NPI:1932511656
Name:GRANT, SHEALYN (LMP)
Entity Type:Individual
Prefix:
First Name:SHEALYN
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13712 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2698
Mailing Address - Country:US
Mailing Address - Phone:360-574-5944
Mailing Address - Fax:360-574-6430
Practice Address - Street 1:13712 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2698
Practice Address - Country:US
Practice Address - Phone:360-574-5944
Practice Address - Fax:360-574-6430
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91-2087673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor