Provider Demographics
NPI:1215145248
Name:GRACE CHIROPRACTIC
Entity type:Organization
Organization Name:GRACE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-242-9600
Mailing Address - Street 1:5730 BUFORD HWY STE L
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2569
Mailing Address - Country:US
Mailing Address - Phone:770-242-9600
Mailing Address - Fax:770-242-9621
Practice Address - Street 1:5730 BUFORD HWY STE L
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2569
Practice Address - Country:US
Practice Address - Phone:770-242-9600
Practice Address - Fax:770-242-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO5491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7156Medicare ID - Type UnspecifiedGROUP NUMBER