Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4303 | KY |
NPI | 1013003631 |
---|---|
Provider Name | Anthony Wayne Grant |
First Address | Columbia, KY 42728 |
Second Address | Columbia, KY 42728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000330968 | BLUE CROSS PIN (01) | KY |
85900413 | (05) | KY |
U57929 | (02) | KY |