Provider Demographics
NPI:1144987363
Name:KONSTANZER, GRACE ELLEN (DC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ELLEN
Last Name:KONSTANZER
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 1:6 VENTURE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3340
Mailing Address - Country:US
Mailing Address - Phone:949-559-6030
Mailing Address - Fax:949-559-6037
Practice Address - Street 1:6 VENTURE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3340
Practice Address - Country:US
Practice Address - Phone:949-559-6030
Practice Address - Fax:949-559-6037
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor