Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC294260 | CA |
NPI | 1083768717 |
---|---|
Provider Name | Dr. Grace Phelps |
First Address | Redlands, CA 92373-8050 |
Second Address | Redlands, CA 92373-8050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |