Provider Demographics
NPI:1316028111
Name:GRUBBS, WILLIAM DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:GRUBBS
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:PO BOX 2008
Mailing Address - Street 2:2125 NATIONAL ROAD
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0206
Mailing Address - Country:US
Mailing Address - Phone:304-242-5599
Mailing Address - Fax:304-243-0884
Practice Address - Street 1:2125 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-0206
Practice Address - Country:US
Practice Address - Phone:304-242-5599
Practice Address - Fax:304-243-0884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV293111N00000X
PADC-1813-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131248000Medicaid
WVT32320Medicare UPIN
WV0485472Medicare PIN