Provider Demographics
NPI:1710022348
Name:GRUSSING, JONATHAN JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAY
Last Name:GRUSSING
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 1:23 NORTH MAIN STREET
Mailing Address - Street 2:P.O. BOX 793
Mailing Address - City:CLARA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56222-0793
Mailing Address - Country:US
Mailing Address - Phone:320-847-3511
Mailing Address - Fax:320-847-3752
Practice Address - Street 1:23 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLARA CITY
Practice Address - State:MN
Practice Address - Zip Code:56222-0793
Practice Address - Country:US
Practice Address - Phone:320-847-3511
Practice Address - Fax:320-847-3752
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN129MOGROtherBCBS INDIVIDUAL ID
MN128M9HEOtherBCBS GROUP ID NUMBER
MN129MOGROtherBCBS INDIVIDUAL ID