Provider Demographics
NPI:1851335806
Name:GROSMAN, LARRY W (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:GROSMAN
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 1:5410 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4210
Mailing Address - Country:US
Mailing Address - Phone:336-292-9779
Mailing Address - Fax:336-292-9953
Practice Address - Street 1:5410 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4210
Practice Address - Country:US
Practice Address - Phone:336-292-9779
Practice Address - Fax:336-292-9953
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCACNOther330203
NC238889OtherMAMSI
NC4289OtherPARTNERS
NC08461OtherBCBS
NC4409087OtherUNITED HEALTHCARE
NC89-08461Medicaid
NC244219Medicare ID - Type Unspecified
NCT64293Medicare UPIN