Provider Demographics
NPI:1972678035
Name:GRANT, DANIEL COREY (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:COREY
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 1:3366 E RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5738
Mailing Address - Country:US
Mailing Address - Phone:602-502-2602
Mailing Address - Fax:480-786-6997
Practice Address - Street 1:2510 W CHANDLER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4919
Practice Address - Country:US
Practice Address - Phone:480-786-9222
Practice Address - Fax:480-786-6997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74033Medicare ID - Type UnspecifiedMEDICARE CHIRO GPIN#
AZ74034Medicare ID - Type UnspecifiedMEDICARE PT GPIN#