Provider Demographics
NPI:1790311694
Name:GRICE, JOSEPH JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JACOB
Last Name:GRICE
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 1:515 MYOMA RD
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2323
Mailing Address - Country:US
Mailing Address - Phone:724-776-9977
Mailing Address - Fax:
Practice Address - Street 1:515 MYOMA RD
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2323
Practice Address - Country:US
Practice Address - Phone:724-776-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor