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General NPI Number Information
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NPI Number | 1811325038
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Entity Type | Organization
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Legal Business Name | BRODEUR GRACE LLC
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 1250 WARWICK AVE
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City | WARWICK
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State | RI
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Zip | 02888-4149
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Country | US
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Telephone | 401-463-9520
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Fax | 401-463-9457
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Provider Business Mailing Address
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Address Line | 1250 WARWICK AVE
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City | WARWICK
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State | RI
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Zip | 02888-4149
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Country | US
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Telephone | 401-463-9520
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Fax | 401-463-9457
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. ROBERT WILLIAM GRACE
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Credential | D.C.
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Telephone | 401-463-9520
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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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