Provider Demographics
NPI:1083151831
Name:GRUBER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:GRUBER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-254-3300
Mailing Address - Street 1:20 TECHNOLOGY DR
Mailing Address - Street 2:#4
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9181
Mailing Address - Country:US
Mailing Address - Phone:802-254-3300
Mailing Address - Fax:802-254-9068
Practice Address - Street 1:20 TECHNOLOGY DR
Practice Address - Street 2:#4
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9181
Practice Address - Country:US
Practice Address - Phone:802-254-3300
Practice Address - Fax:802-254-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0001135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010682Medicaid
V01221Medicare UPIN
VT1010682Medicaid