Provider Demographics
NPI:1356402267
Name:GRANDT, CARRIE SUE (DC)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:SUE
Last Name:GRANDT
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 1:76 COLONIAL DR
Mailing Address - Street 2:UNIT 5
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9325
Mailing Address - Country:US
Mailing Address - Phone:802-295-5845
Mailing Address - Fax:
Practice Address - Street 1:222 HOLIDAY DR
Practice Address - Street 2:SUITE 22
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-2043
Practice Address - Country:US
Practice Address - Phone:802-295-9360
Practice Address - Fax:802-295-9360
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00069591OtherBLUE CROSS BLUE SHIELD