Provider Demographics
NPI:1174637839
Name:CATER, GRACE RENA MAE (DC)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:RENA MAE
Last Name:CATER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 POST OAK LANE #9
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:617-823-5020
Mailing Address - Fax:508-651-0204
Practice Address - Street 1:1212 HANCOCK ST
Practice Address - Street 2:FIRST SPINE & REHAB
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-745-0555
Practice Address - Fax:617-745-0554
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36300OtherBCBS
MA2980328OtherAETNA
U30913Medicare UPIN
MAY36300Medicare ID - Type Unspecified