Provider Demographics
NPI:1376588327
Name:GROSSMAN, DANIEL H (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
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 1:2171 BERNADETTE CT
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2217
Mailing Address - Country:US
Mailing Address - Phone:732-449-3040
Mailing Address - Fax:732-449-3048
Practice Address - Street 1:14 CHERRY TREE FARM RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2238
Practice Address - Country:US
Practice Address - Phone:732-671-3535
Practice Address - Fax:732-671-0829
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00503800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ542066181DOtherBLUE CROSS BLUE SHIELD
NJ2898398OtherAETNA
NJ2221108000OtherAMERIHEALTH
NJP876527OtherOXFORD
NJ542066181DOtherBLUE CROSS BLUE SHIELD
NJU70002Medicare UPIN