Provider Demographics
NPI:1457710428
Name:GRACE WELLNESS CENTER
Entity Type:Organization
Organization Name:GRACE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LUNDY
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-774-0055
Mailing Address - Street 1:3131 E 29TH ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2736
Mailing Address - Country:US
Mailing Address - Phone:979-774-0055
Mailing Address - Fax:979-776-0197
Practice Address - Street 1:3131 E 29TH ST
Practice Address - Street 2:BUILDING A
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2736
Practice Address - Country:US
Practice Address - Phone:979-774-0055
Practice Address - Fax:979-776-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX95833Medicare UPIN