Provider Demographics
NPI:1134146665
Name:GROSSO, JOSEPH TODD (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TODD
Last Name:GROSSO
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 1:615 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-736-1680
Mailing Address - Fax:413-736-6057
Practice Address - Street 1:615 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-736-1680
Practice Address - Fax:413-736-6057
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA662678OtherACN
MA21740OtherHEALTH NEW ENGLAND
MA1611607Medicaid
MA350049035OtherMEDICARE RAILROAD
MAY36523OtherBCBS MA
MA355387OtherTUFTS HEALTH PLAN
MA351284OtherHPHC
MA662678OtherACN
MA355387OtherTUFTS HEALTH PLAN