Provider Demographics
NPI:1942796263
Name:GILBREATH, GRACE (DC)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 PACE ST STE B
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-6660
Mailing Address - Country:US
Mailing Address - Phone:770-786-2818
Mailing Address - Fax:
Practice Address - Street 1:2125 PACE ST STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6660
Practice Address - Country:US
Practice Address - Phone:770-786-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO10079111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty