Provider Demographics
NPI:1083007348
Name:GRANDLE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GRANDLE CHIROPRACTIC PC
Other - Org Name:ALKI ART & WELLNESS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-963-2086
Mailing Address - Street 1:209A SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1820
Mailing Address - Country:US
Mailing Address - Phone:805-963-2086
Mailing Address - Fax:805-963-2087
Practice Address - Street 1:209A SANTA BARBARA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1820
Practice Address - Country:US
Practice Address - Phone:805-963-2086
Practice Address - Fax:805-963-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty