Individual
GRADY MATTHEW BIRDSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1201 5TH AVE, MOLINE, IL 61265-1331
(309) 764-8821
(309) 757-4773
Mailing address
1201 5TH AVE, MOLINE, IL 61265-1331
(309) 764-8821
(309) 757-4773
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8182020
BLUE CROSS BS
IL
Enumeration date
09/06/2006
Last updated
12/03/2007
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