Provider Demographics
NPI:1306844337
Name:GROSSMAN, BRUCE HARVEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HARVEY
Last Name:GROSSMAN
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 1:1001 RARITAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3667
Mailing Address - Country:US
Mailing Address - Phone:732-572-2225
Mailing Address - Fax:732-985-4875
Practice Address - Street 1:1001 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3667
Practice Address - Country:US
Practice Address - Phone:732-572-2225
Practice Address - Fax:732-985-4875
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC001447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor