Provider Demographics
NPI:1700178837
Name:GRANT, JACQUELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
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 1:816 PASEO DEL REY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7835
Mailing Address - Country:US
Mailing Address - Phone:619-869-8900
Mailing Address - Fax:619-869-8902
Practice Address - Street 1:816 PASEO DEL REY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7835
Practice Address - Country:US
Practice Address - Phone:619-869-8900
Practice Address - Fax:619-869-8902
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10022111N00000X
CA32853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor