Provider Demographics
NPI:1881853836
Name:GROMALA, THERESA JOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:JOAN
Last Name:GROMALA
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 1:2200 W 89TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2007
Mailing Address - Country:US
Mailing Address - Phone:612-599-9625
Mailing Address - Fax:
Practice Address - Street 1:2200 W 89TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2007
Practice Address - Country:US
Practice Address - Phone:612-599-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2278111NX0100X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No1744R1102XOther Service ProvidersSpecialistResearch Study