Provider Demographics
NPI:1417973702
Name:GRIVAS, PHILIP C (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:C
Last Name:GRIVAS
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 1:258 NJ 35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-593-9962
Mailing Address - Fax:
Practice Address - Street 1:258 NJ 35 SOUTH
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-593-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00577300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU85926Medicare UPIN
NJ098498Medicare ID - Type UnspecifiedCMS GROUP NUMBER
NJ049389U2QMedicare ID - Type UnspecifiedCMS PROVIDER IDEN. NUM.