Provider Demographics
NPI:1164555405
Name:GRACE, ROBERT DAVIS (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVIS
Last Name:GRACE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1428
Mailing Address - Country:US
Mailing Address - Phone:770-497-9700
Mailing Address - Fax:
Practice Address - Street 1:3800 PLEASANT HILL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1428
Practice Address - Country:US
Practice Address - Phone:770-497-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO03103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1346312816OtherCORPORATE NPI
GA35ZCBRWMedicare ID - Type Unspecified