Provider Demographics
NPI:1932278801
Name:GRANT, JOHN P (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
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 1:1105 48TH AVE N
Mailing Address - Street 2:STE 106
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5419
Mailing Address - Country:US
Mailing Address - Phone:843-497-5197
Mailing Address - Fax:
Practice Address - Street 1:1105 48TH AVE N STE 106
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5419
Practice Address - Country:US
Practice Address - Phone:843-497-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2736Medicaid