Organization
GRANT CHIROPRACTIC CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK GRANT D.C. (PRESIDENT)
(219) 362-3766
Entity
Organization
Contact information
Practice address
451 PINE LAKE AVE, LA PORTE, IN 46350-2314
(219) 362-3766
(219) 325-8715
Mailing address
451 PINE LAKE AVE, LA PORTE, IN 46350-2314
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001545
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100385070A
—
IN
Enumeration date
01/18/2007
Last updated
12/20/2007
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