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General NPI Number Information
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NPI Number | 1083007348
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Entity Type | Organization
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Legal Business Name | GRANDLE CHIROPRACTIC PC
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 209A SANTA BARBARA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93101-1820
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Country | US
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Telephone | 805-963-2086
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Fax | 805-963-2087
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Provider Business Mailing Address
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Address Line | 209A SANTA BARBARA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93101-1820
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Country | US
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Telephone | 805-963-2086
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Fax | 805-963-2087
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC D GRANDLE
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Credential | D.C.
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Telephone | 805-963-2086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC30015
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License Number State | CA
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