Provider Demographics
NPI:1982793857
Name:GRACE, DAIVD M (DC)
Entity type:Individual
Prefix:
First Name:DAIVD
Middle Name:M
Last Name:GRACE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:HYGIENE
Mailing Address - State:CO
Mailing Address - Zip Code:80533-0042
Mailing Address - Country:US
Mailing Address - Phone:303-776-2528
Mailing Address - Fax:303-651-0441
Practice Address - Street 1:11961N 75TH ST
Practice Address - Street 2:
Practice Address - City:HYGIENE
Practice Address - State:CO
Practice Address - Zip Code:80533
Practice Address - Country:US
Practice Address - Phone:303-776-2528
Practice Address - Fax:303-651-0441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC45043Medicare ID - Type Unspecified
COU86551Medicare UPIN