Provider Demographics
NPI:1336116250
Name:GRUPP, MAX E (DC)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:E
Last Name:GRUPP
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 1:376 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-355-1148
Mailing Address - Fax:
Practice Address - Street 1:376 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053
Practice Address - Country:US
Practice Address - Phone:215-357-8948
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001157L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0633390Medicaid
PA0633390Medicaid
T29110Medicare UPIN