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General NPI Number Information
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NPI Number | 1720901960
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Entity Type | Organization
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Legal Business Name | GRACE SPINE LLC
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 7685 103RD ST STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32210-9325
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Country | US
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Telephone | 314-629-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 27 WALNUT KNOLL CT
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City | SAINT CHARLES
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State | MO
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Zip | 63304-4549
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Country | US
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Telephone | 314-629-5794
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON COREY GOODMAN
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Credential | DC
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Telephone | 314-629-5794
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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 |
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License Number State |
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