Provider Demographics
NPI:1497151153
Name:JACKSON GRUEB, BRITTANY ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:ANN
Last Name:JACKSON GRUEB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:BRITTANY
Other - Middle Name:ANN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1107 MT RUSHMORE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3619
Mailing Address - Country:US
Mailing Address - Phone:605-341-9100
Mailing Address - Fax:605-341-9200
Practice Address - Street 1:1107 MT RUSHMORE RD
Practice Address - Street 2:STE 2
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3619
Practice Address - Country:US
Practice Address - Phone:605-341-9100
Practice Address - Fax:605-341-9200
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1262OtherSD STATE LICENSE