Provider Demographics
NPI:1043265879
Name:GROSSMAN CHIROPRACTIC & PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GROSSMAN CHIROPRACTIC & PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-438-8700
Mailing Address - Street 1:397 RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1715
Mailing Address - Country:US
Mailing Address - Phone:732-438-8700
Mailing Address - Fax:732-438-8705
Practice Address - Street 1:397 RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1715
Practice Address - Country:US
Practice Address - Phone:732-438-8700
Practice Address - Fax:732-438-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00646300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty