MEDICARE: GRACE SYN CHIROPRACTIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC22869	CA

General Provider Information

NPI Number	:	1598891350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE SYN CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	1611 S CATALINA AVE
Second Line	:	SUITE 100
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5255
Country	:	US
Telephone Number	:	310-540-5529
Fax Number	:	310-540-3866

Provider Business Practice Location Address
First Line	:	1611 S CATALINA AVE
Second Line	:	SUITE 100
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5255
Country	:	US
Telephone Number	:	310-540-5529
Fax Number	:	310-540-3866

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. GRACE J SYN
Credential	:	DC
Telephone Number	:	310-540-5529

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/03/2008

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