Individual
LISA BRADY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
290 W. KELLY ST., JACKSON, WY 83001
(307) 739-0553
Mailing address
PO BOX 1426, WILSON, WY 83014-1426
(307) 739-0553
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
510
WY
Other
Enumeration date
10/21/2008
Last updated
10/21/2008
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