Provider Demographics
NPI:1871635466
Name:GRUDER, MARTIN IRWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:IRWIN
Last Name:GRUDER
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:PO BOX 2115
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762
Mailing Address - Country:US
Mailing Address - Phone:508-699-2228
Mailing Address - Fax:508-695-3560
Practice Address - Street 1:112A PARK ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1213
Practice Address - Country:US
Practice Address - Phone:508-699-2228
Practice Address - Fax:508-695-3560
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA983111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1613634Medicaid
Y35732Medicare ID - Type Unspecified