Provider Demographics
NPI:1326288127
Name:GROBELNY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:GROBELNY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROBELNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-458-8258
Mailing Address - Street 1:PO BOX 1936
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1936
Mailing Address - Country:US
Mailing Address - Phone:360-458-8258
Mailing Address - Fax:360-458-8257
Practice Address - Street 1:10501 CREEK ST SE
Practice Address - Street 2:SUITE 2
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597
Practice Address - Country:US
Practice Address - Phone:360-458-8258
Practice Address - Fax:360-458-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA09001304.1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty