Provider Demographics
NPI:1568872802
Name:DALY GRACE PA
Entity Type:Organization
Organization Name:DALY GRACE PA
Other - Org Name:INTEGRATIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:BS DC
Authorized Official - Phone:207-878-3030
Mailing Address - Street 1:1321 WASHINGTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3636
Mailing Address - Country:US
Mailing Address - Phone:207-878-3030
Mailing Address - Fax:
Practice Address - Street 1:1321 WASHINGTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3636
Practice Address - Country:US
Practice Address - Phone:207-878-3030
Practice Address - Fax:207-878-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty