Provider Demographics
NPI:1568114106
Name:GRISIUS CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:GRISIUS CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-871-3583
Mailing Address - Street 1:1101 N CROSBY ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2537
Mailing Address - Country:US
Mailing Address - Phone:847-871-3583
Mailing Address - Fax:
Practice Address - Street 1:1642 W BELMONT AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3018
Practice Address - Country:US
Practice Address - Phone:847-871-3583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy