Provider Demographics
NPI:1437366556
Name:GROTHMAN, MARIE T (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:T
Last Name:GROTHMAN
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 1:1460 WILMETTE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3712
Mailing Address - Country:US
Mailing Address - Phone:630-665-4177
Mailing Address - Fax:
Practice Address - Street 1:845 N LAKE ST STE 1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3178
Practice Address - Country:US
Practice Address - Phone:630-844-1244
Practice Address - Fax:630-844-1199
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1710986179OtherCLINIC NPI
ID4515209OtherBCBS
ID4515209OtherBCBS