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General NPI Number Information
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NPI Number | 1750897286
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Entity Type | Organization
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Legal Business Name | MINIM INC.
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 103 E CONNECTICUT AVE
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City | EDGEWATER
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State | FL
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Zip | 32132-2360
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Country | US
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Telephone | 386-423-7572
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Fax |
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Provider Business Mailing Address
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Address Line | 4516 SAXON DR
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-4137
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Country | US
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Telephone | 386-506-1610
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTIAN PATRICK GRAUSE
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Credential | DC
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Telephone | 386-506-1610
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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 | 10371
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License Number State | FL
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