Provider Demographics
NPI:1447390836
Name:GRUNEWALD CHIROPRACTIC CLINIC, LTD.
Entity Type:Organization
Organization Name:GRUNEWALD CHIROPRACTIC CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRUNEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-233-2254
Mailing Address - Street 1:1630 S GALENA AVE STE A
Mailing Address - Street 2:P.O. BOX 754
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-2518
Mailing Address - Country:US
Mailing Address - Phone:815-233-2254
Mailing Address - Fax:815-233-2253
Practice Address - Street 1:1630 S GALENA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-2518
Practice Address - Country:US
Practice Address - Phone:815-233-2254
Practice Address - Fax:815-233-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07123205OtherBCBS
ILU62604Medicare UPIN
IL07123205OtherBCBS