Provider Demographics
NPI:1700207149
Name:GRISSMAN, JON (DC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:GRISSMAN
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 1:430 S BROAD ST
Mailing Address - Street 2:STE 130
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3796
Mailing Address - Country:US
Mailing Address - Phone:507-387-5591
Mailing Address - Fax:507-205-2838
Practice Address - Street 1:430 S BROAD ST
Practice Address - Street 2:SUITE 130
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3789
Practice Address - Country:US
Practice Address - Phone:507-387-5591
Practice Address - Fax:507-387-5397
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400122107Medicare PIN