Provider Demographics
NPI:1396023313
Name:GRAUSE, CHRISTIAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:PATRICK
Last Name:GRAUSE
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 1:4516 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4137
Mailing Address - Country:US
Mailing Address - Phone:386-506-1610
Mailing Address - Fax:
Practice Address - Street 1:103 E CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-2360
Practice Address - Country:US
Practice Address - Phone:386-423-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG303ZOtherMEDICARE PTAN
FL220FMOtherBC/BS