Provider Demographics
NPI:1346286812
Name:GROBE, DANA SHANTEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:SHANTEL
Last Name:GROBE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1825
Mailing Address - Country:US
Mailing Address - Phone:636-937-5577
Mailing Address - Fax:636-937-5579
Practice Address - Street 1:308 BAILEY RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1825
Practice Address - Country:US
Practice Address - Phone:636-937-5577
Practice Address - Fax:636-937-5579
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002006991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO191563OtherBLUECROSS BLUESHIELD
MO90-01469769OtherGREAT WEST
MO482692OtherHEALTHLINK
MO2214198OtherUNITED HEALTHCARE
MO1032925OtherASHN
MOU89542Medicare UPIN