Provider Demographics
NPI:1700826450
Name:GROSSENHEIDER, TONI (DC)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:GROSSENHEIDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 58TH DR E
Mailing Address - Street 2:S.R. 70 STE 103
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6110
Mailing Address - Country:US
Mailing Address - Phone:941-756-5555
Mailing Address - Fax:941-756-5556
Practice Address - Street 1:9070 58TH DR E
Practice Address - Street 2:S.R. 70 STE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-6110
Practice Address - Country:US
Practice Address - Phone:941-756-5555
Practice Address - Fax:941-756-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006587111N00000X
FLCH9575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU68203Medicare UPIN
MO990200509Medicare PIN