Provider Demographics
NPI:1558813915
Name:JOYCE GRACE DC LLC
Entity Type:Organization
Organization Name:JOYCE GRACE DC LLC
Other - Org Name:AFFORDABLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-639-1770
Mailing Address - Street 1:119 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3654
Mailing Address - Country:US
Mailing Address - Phone:941-639-1770
Mailing Address - Fax:941-639-1770
Practice Address - Street 1:119 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3654
Practice Address - Country:US
Practice Address - Phone:941-639-1770
Practice Address - Fax:941-639-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55228AOtherMEDICARE ID UNSPECIFIED
FL55228AOtherMEDICARE ID UNSPECIFIED