Provider Demographics
NPI:1639177330
Name:GRUENENFELDER, ROBERT JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:GRUENENFELDER
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 1:711 HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1926
Mailing Address - Country:US
Mailing Address - Phone:423-337-3761
Mailing Address - Fax:423-337-9705
Practice Address - Street 1:711 HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1926
Practice Address - Country:US
Practice Address - Phone:423-337-3761
Practice Address - Fax:423-337-9705
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC000619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11366966OtherCAQH ID
TN4067808OtherBLUE CROSS
TNP00056709OtherRAILROAD MEDICARE
TN3674946Medicaid
TN11366966OtherCAQH ID
TN3674946Medicare PIN