Provider Demographics
NPI:1093848855
Name:GRUMISH CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:GRUMISH CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GRUMISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-939-0990
Mailing Address - Street 1:40 BRIARCLIFF PROFESSIONAL CENTER
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1775
Mailing Address - Country:US
Mailing Address - Phone:815-939-0990
Mailing Address - Fax:815-939-0822
Practice Address - Street 1:40 BRIARCLIFF PROFESSIONAL CENTER
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1775
Practice Address - Country:US
Practice Address - Phone:815-939-0990
Practice Address - Fax:815-939-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4682102OtherBCBS
IL555940Medicare ID - Type Unspecified