Provider Demographics
NPI:1083163372
Name:GROERICH CHIROPRACTIC AND WELLNESS LLC
Entity Type:Organization
Organization Name:GROERICH CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:GROERICH CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROERICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-456-2761
Mailing Address - Street 1:1034 S BRENTWOOD BLVD STE 300B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1203
Mailing Address - Country:US
Mailing Address - Phone:314-456-2761
Mailing Address - Fax:314-644-2309
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 300B
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1203
Practice Address - Country:US
Practice Address - Phone:314-456-2761
Practice Address - Fax:314-644-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015001863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty