Provider Demographics
NPI:1629615356
Name:CLEARLY GRACE CONCIERGE CHIROPRACTIC, LLC.
Entity Type:Organization
Organization Name:CLEARLY GRACE CONCIERGE CHIROPRACTIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-265-4465
Mailing Address - Street 1:8009 GLASTONBURY PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2141
Mailing Address - Country:US
Mailing Address - Phone:321-265-4465
Mailing Address - Fax:
Practice Address - Street 1:8009 GLASTONBURY PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2141
Practice Address - Country:US
Practice Address - Phone:321-265-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service