Provider Demographics
NPI:1043394182
Name:GRUZA, JOHN F (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:GRUZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1253
Mailing Address - Country:US
Mailing Address - Phone:937-324-2442
Mailing Address - Fax:937-324-5470
Practice Address - Street 1:1834 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1253
Practice Address - Country:US
Practice Address - Phone:937-324-2442
Practice Address - Fax:937-324-5470
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
311463706OtherTAX ID
OH00000020837OtherBLUE CROSS
OH02-39754Medicaid
311463706OtherTAX ID
OHT78999Medicare UPIN
OH02-39754Medicaid