Provider Demographics
NPI:1063485720
Name:GRUBA, GREGORY S (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:GRUBA
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 1:402 SAINT JOSEPH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3081
Mailing Address - Country:US
Mailing Address - Phone:605-791-1770
Mailing Address - Fax:605-791-2368
Practice Address - Street 1:402 SAINT JOSEPH ST STE 2
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3081
Practice Address - Country:US
Practice Address - Phone:605-791-1770
Practice Address - Fax:605-791-2368
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor