Provider Demographics
NPI:1679678841
Name:GRABENSTEIN, EDWARD R (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:GRABENSTEIN
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 1:142 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4975
Mailing Address - Country:US
Mailing Address - Phone:248-628-5433
Mailing Address - Fax:248-628-0292
Practice Address - Street 1:142 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-4975
Practice Address - Country:US
Practice Address - Phone:248-628-5433
Practice Address - Fax:248-628-0292
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33366Medicare ID - Type Unspecified