Provider Demographics
NPI:1043456767
Name:GRASS CHIROPRACTIC
Entity Type:Organization
Organization Name:GRASS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-751-0100
Mailing Address - Street 1:1031 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7362
Mailing Address - Country:US
Mailing Address - Phone:409-751-0100
Mailing Address - Fax:409-751-0700
Practice Address - Street 1:1031 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7362
Practice Address - Country:US
Practice Address - Phone:409-751-0100
Practice Address - Fax:409-751-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3330255OtherCIGNA HEALTHCARE
TX606039OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX7342069OtherAETNA HEALTHCARE
TX3330255OtherCIGNA HEALTHCARE