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General NPI Number Information
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NPI Number | 1063962983
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Entity Type | Organization
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Legal Business Name | DR GRACIES WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 4790 STROUPS HICKOX RD
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City | WEST FARMINGTON
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State | OH
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Zip | 44491-8709
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Country | US
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Telephone | 301-752-1147
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Fax |
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Provider Business Mailing Address
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Address Line | 4790 STROUPS HICKOX RD
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City | WEST FARMINGTON
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State | OH
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Zip | 44491-8709
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Country | US
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Telephone | 301-752-1147
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ELSIE GRACE YUEN
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Credential | DC
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Telephone | 301-752-1147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 4119
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License Number State | OH
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