Individual
GRANT LARIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
502 GEORGE ST, DE PERE, WI 54115-2714
(920) 337-0103
(920) 338-9066
Mailing address
502 GEORGE ST, DE PERE, WI 54115-2714
(920) 337-0103
(920) 338-9066
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5174-12
WI
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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