Provider Demographics
NPI:1124024781
Name:GROSSI, DAVID J (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:GROSSI
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 1:842 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3592
Mailing Address - Country:US
Mailing Address - Phone:724-349-7710
Mailing Address - Fax:724-349-8996
Practice Address - Street 1:842 LAUREL ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3592
Practice Address - Country:US
Practice Address - Phone:724-349-7710
Practice Address - Fax:724-349-8996
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003012L111N00000X
VA0104000646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
605242OtherBLUESHIELD (HIGHMARK)
U16369Medicare UPIN
583804Medicare ID - Type Unspecified