Provider Demographics
NPI:1790723567
Name:GROSSMAN, ADAM DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:DANIEL
Last Name:GROSSMAN
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 1:397 RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1715
Mailing Address - Country:US
Mailing Address - Phone:732-438-8700
Mailing Address - Fax:732-438-8705
Practice Address - Street 1:397 RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1715
Practice Address - Country:US
Practice Address - Phone:732-438-8700
Practice Address - Fax:732-438-8705
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00646300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor