Provider Demographics
NPI:1972560134
Name:BREWER, GRACE (DC)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:BREWER
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 1:7199 W 98TH TER
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2241
Mailing Address - Country:US
Mailing Address - Phone:913-648-5700
Mailing Address - Fax:
Practice Address - Street 1:7199 W 98TH TER
Practice Address - Street 2:SUITE 150
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2241
Practice Address - Country:US
Practice Address - Phone:913-648-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17422010OtherBLUE CROSS/BLUE SHIELD
KSU18738Medicare UPIN
KS0002949Medicare ID - Type Unspecified