Provider Demographics
NPI:1497767909
Name:GROSKOPP, WILLIAM CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:GROSKOPP
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 1:205 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-1197
Mailing Address - Country:US
Mailing Address - Phone:920-756-2151
Mailing Address - Fax:920-756-2152
Practice Address - Street 1:205 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1197
Practice Address - Country:US
Practice Address - Phone:920-756-2151
Practice Address - Fax:920-756-2152
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1608-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE-30001791Medicaid
WIE-30001791Medicaid
WIT62063Medicare UPIN