Healthcare Provider Details

I. General information

NPI: 1285792366
Provider Name (Legal Business Name): GRACE CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W MAIN ST
CABOT AR
72023-2911
US

IV. Provider business mailing address

PO BOX 688
CABOT AR
72023-0688
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-3008
  • Fax: 501-941-3007
Mailing address:
  • Phone: 501-941-3008
  • Fax: 501-941-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1674
License Number StateAR

VIII. Authorized Official

Name: DR. TIMOTHY CLAY GROSS
Title or Position: OWNER
Credential: D.C.
Phone: 501-941-3008