Provider Demographics
NPI:1508904293
Name:GROBELNY, GORDON J (DC)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:J
Last Name:GROBELNY
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:PO BOX 1936
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1936
Mailing Address - Country:US
Mailing Address - Phone:360-458-8258
Mailing Address - Fax:
Practice Address - Street 1:10501 CREEK ST SE STE 2
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597
Practice Address - Country:US
Practice Address - Phone:360-458-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor