Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6715760-1202 | UT |
N | 111NN0400X | Neurology | 6715760-1202 | UT |
Y | 111NR0400X | Rehabilitation Chiropractor | 6715760-1202 | UT |
N | 111NS0005X | Chiropractic Sports Physician | 6715760-1202 | UT |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 6715760-1202 | UT |
NPI | 1992769046 |
---|---|
Provider Name | Dr. Thomas Earl Grant JR. |
First Address | Nauvoo, IL 62354-2037 |
Second Address | Nauvoo, IL 62354-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 14/02/2022 |