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General NPI Number Information
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NPI Number | 1821293440
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Entity Type | Individual
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Provider Name | JOHN GRASSAM D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 555 NW LAKE WHITNEY PL STE 105
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1623
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Country | US
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Telephone | 772-237-2080
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Fax | 772-237-2086
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Provider Business Mailing Address
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Address Line | 555 NW LAKE WHITNEY PL STE 105
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-1623
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Country | US
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Telephone | 772-237-2080
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Fax | 772-237-2086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH7964
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License Number State | FL
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