Individual
DR. MARK CHARLES GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
451 PINE LAKE AVE, LA PORTE, IN 46350-2314
(219) 362-3766
Mailing address
451 PINE LAKE AVE, LA PORTE, IN 46350-2314
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001545
IN
Other
Enumeration date
01/24/2008
Last updated
01/24/2008
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