MEDICARE: MR. RICARDO GRASS

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	21100143	FL

General Provider Information

NPI Number	:	1962545111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICARDO GRASS

Provider Business Mailing Address
First Line	:	3970 W FLAGLER ST
Second Line	:	SUITE 104
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1642
Country	:	US
Telephone Number	:	305-448-2470
Fax Number	:	305-448-2405

Provider Business Practice Location Address
First Line	:	3970 W FLAGLER ST
Second Line	:	SUITE 104
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1642
Country	:	US
Telephone Number	:	305-448-2470
Fax Number	:	305-448-2405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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