Provider Demographics
NPI: | 1932413077 |
---|---|
Name: | GRIGGS, SHANTE (PHARMD, DN) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SHANTE |
Middle Name: | |
Last Name: | GRIGGS |
Suffix: | |
Gender: | F |
Credentials: | PHARMD, DN |
Other - Prefix: | DR |
Other - First Name: | SHANTE |
Other - Middle Name: | |
Other - Last Name: | JOHNSON |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | PHARMD, DN |
Mailing Address - Street 1: | 320 E 21ST ST UNIT 405 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60616-4979 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 312-872-7232 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3330 N MILWAUKEE AVE |
Practice Address - Street 2: | |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60641-4001 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-282-2686 |
Practice Address - Fax: | 773-282-2688 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-07-30 |
Last Update Date: | 2023-01-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 181000392 | 133N00000X, 174400000X, 208100000X, 2081N0008X, 2081P2900X, 2081S0010X, 172P00000X |
133NN1002X, 174H00000X | ||
NM | 01013 | 172P00000X, 204C00000X, 208100000X |
IL | 051292165 | 183500000X, 1835N1003X, 1835P0018X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 172P00000X | Other Service Providers | Naprapath | |
No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | |
No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
No | 174400000X | Other Service Providers | Specialist | |
No | 174H00000X | Other Service Providers | Health Educator | |
No | 183500000X | Pharmacy Service Providers | Pharmacist | |
No | 1835N1003X | Pharmacy Service Providers | Pharmacist | Nutrition Support |
No | 1835P0018X | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | |
No | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |