Provider Demographics
NPI:1245290915
Name:GRANT, BERNADETTE DOLORES (DC)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:DOLORES
Last Name:GRANT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 W FLAMINGO RD
Mailing Address - Street 2:SUITE 112A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6447
Mailing Address - Country:US
Mailing Address - Phone:702-696-1444
Mailing Address - Fax:702-932-6102
Practice Address - Street 1:9330 W FLAMINGO RD
Practice Address - Street 2:SUITE 112A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6447
Practice Address - Country:US
Practice Address - Phone:702-696-1444
Practice Address - Fax:702-932-6102
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-01015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39602Medicare PIN
NVV00410Medicare UPIN