Provider Demographics
NPI:1528002169
Name:EBERT GROMMET, DEBORAH LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:EBERT GROMMET
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 1:1055 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-1415
Mailing Address - Country:US
Mailing Address - Phone:636-475-4477
Mailing Address - Fax:636-475-4477
Practice Address - Street 1:1055 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:HERCULANEUM
Practice Address - State:MO
Practice Address - Zip Code:63048-1415
Practice Address - Country:US
Practice Address - Phone:636-475-4477
Practice Address - Fax:636-475-4477
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5944OtherBC BS
MO1830285OtherTAX ID NUMBER
MO4406400OtherUNITED HEALTH CARE
MO4406400OtherUNITED HEALTH CARE