Provider Demographics
NPI:1164761128
Name:HRABOVSKY, GRANT ELMER (DC)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:ELMER
Last Name:HRABOVSKY
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 1:5770 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-2116
Mailing Address - Country:US
Mailing Address - Phone:412-708-3887
Mailing Address - Fax:412-774-1842
Practice Address - Street 1:5770 BUTLER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-2116
Practice Address - Country:US
Practice Address - Phone:412-708-3887
Practice Address - Fax:412-774-1842
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029920860001Medicaid