Provider Demographics
NPI:1447348289
Name:BROWN-GRANTHAM, PEGGY JEAN (DC, PA)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JEAN
Last Name:BROWN-GRANTHAM
Suffix:
Gender:F
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 ANTIOCH RD.
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1701
Mailing Address - Country:US
Mailing Address - Phone:913-685-0022
Mailing Address - Fax:913-685-9298
Practice Address - Street 1:12631 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1701
Practice Address - Country:US
Practice Address - Phone:913-685-0022
Practice Address - Fax:913-685-9298
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS4540111N00000X
KS4540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0008614Medicare ID - Type Unspecified
KSU79804Medicare UPIN