Provider Demographics
NPI:1821293440
Name:GRASSAM, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GRASSAM
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 1:555 NW LAKE WHITNEY PL STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1623
Mailing Address - Country:US
Mailing Address - Phone:772-237-2080
Mailing Address - Fax:772-237-2086
Practice Address - Street 1:555 NW LAKE WHITNEY PL STE 105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1623
Practice Address - Country:US
Practice Address - Phone:772-237-2080
Practice Address - Fax:772-237-2086
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor