Healthcare Provider Details

I. General information

NPI: 1174782874
Provider Name (Legal Business Name): GRACE H HAMEISTER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 LEXINGTON AVE
LOS ANGELES CA
90029-2122
US

IV. Provider business mailing address

4254 LEXINGTON AVE
LOS ANGELES CA
90029-2122
US

V. Phone/Fax

Practice location:
  • Phone: 510-717-3482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number26730
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number26730
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number26730
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number26730
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number26730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: