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General NPI Number Information
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NPI Number | 1982883773
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Entity Type | Organization
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Legal Business Name | GRANDE CHIROPRACTIC INC.
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 11 W DEL MAR BLVD 100
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City | PASADENA
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State | CA
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Zip | 91105-2505
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Country | US
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Telephone | 626-578-7544
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Fax |
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Provider Business Mailing Address
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Address Line | 11 W DEL MAR BLVD SUITE 100
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City | PASADENA
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State | CA
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Zip | 91105-2505
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Country | US
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Telephone |
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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. VINCENT SAMUEL GRANDE
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Credential | D.C.
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Telephone | 626-578-7544
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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 | DC30502
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License Number State | CA
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