Provider Demographics
NPI:1265406292
Name:GRANT, BILLY D (DC)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:D
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 1:1222 SKYLINE DRIVE
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240
Mailing Address - Country:US
Mailing Address - Phone:270-889-5355
Mailing Address - Fax:270-885-2356
Practice Address - Street 1:1222 SKYLINE DR STE A&B
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4968
Practice Address - Country:US
Practice Address - Phone:270-885-2366
Practice Address - Fax:270-885-2356
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000215456OtherBLUE CROSS
KY85038107Medicaid
KY6043801Medicare PIN