Provider Demographics
NPI:1710306998
Name:SUZANNE P GRONDIN DC PA
Entity Type:Organization
Organization Name:SUZANNE P GRONDIN DC PA
Other - Org Name:CHIROCARE CENTER, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRONDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-729-4645
Mailing Address - Street 1:124 MAINE ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2072
Mailing Address - Country:US
Mailing Address - Phone:207-729-4645
Mailing Address - Fax:207-721-1189
Practice Address - Street 1:124 MAINE ST
Practice Address - Street 2:SUITE 215
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2072
Practice Address - Country:US
Practice Address - Phone:207-729-4645
Practice Address - Fax:207-721-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1790102085OtherNPI