Provider Demographics
NPI:1851416200
Name:GROSBOLL, MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GROSBOLL
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 1:9590 SHENSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6039
Mailing Address - Country:US
Mailing Address - Phone:720-201-4292
Mailing Address - Fax:
Practice Address - Street 1:9590 SHENSTONE WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-6039
Practice Address - Country:US
Practice Address - Phone:720-201-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor