Basic Information
| Provider Information | |||||||||
| NPI: | 1194135897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRAND HEALTH WELLNESS & ACUPUNCTURE LLC | ||||||||
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| OtherOrganizationName: | SPINE & NEUROLOGY CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 MEXICO RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146901525 | ||||||||
| FaxNumber: | 6364425036 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 MEXICO RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146901525 | ||||||||
| FaxNumber: | 6364425036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | PATT | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3146901525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.C. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 2006033498 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.