Individual
DR. GRANT LOUIS MODORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
303 HESTER ST W, DUNDAS, MN 55019-3970
(507) 645-0333
(507) 645-4047
Mailing address
303 HESTER ST W, DUNDAS, MN 55019-3970
(507) 645-0333
(507) 645-4047
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4075
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54F46CO
BLUECROSS BLUESHEILD
MN
01
—
54F47MO
BCBS INDIVIDUAL PROVIDER#
MN
Enumeration date
02/07/2007
Last updated
03/06/2020
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