Provider Demographics
NPI:1770792814
Name:GRACE, EMILY LAUREL (DC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREL
Last Name:GRACE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:KALVASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7944 POCKET RD
Mailing Address - Street 2:#46
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5704
Mailing Address - Country:US
Mailing Address - Phone:530-902-2105
Mailing Address - Fax:
Practice Address - Street 1:2114 N ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5712
Practice Address - Country:US
Practice Address - Phone:916-993-3200
Practice Address - Fax:916-993-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB410SMedicare PIN