Provider Demographics
NPI:1689830002
Name:GRUBER CHIROPRACTIC PS
Entity Type:Organization
Organization Name:GRUBER CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-853-3353
Mailing Address - Street 1:3608 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1135
Mailing Address - Country:US
Mailing Address - Phone:253-853-3353
Mailing Address - Fax:
Practice Address - Street 1:3608 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1135
Practice Address - Country:US
Practice Address - Phone:253-853-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8858079Medicare PIN