Provider Demographics
NPI:1912022278
Name:GROTTS, ANTHONY G (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:GROTTS
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 1:853 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NUCLA
Mailing Address - State:CO
Mailing Address - Zip Code:81424-0454
Mailing Address - Country:US
Mailing Address - Phone:970-864-7480
Mailing Address - Fax:970-864-7482
Practice Address - Street 1:853 MAIN ST
Practice Address - Street 2:
Practice Address - City:NUCLA
Practice Address - State:CO
Practice Address - Zip Code:81424-0454
Practice Address - Country:US
Practice Address - Phone:970-864-7480
Practice Address - Fax:970-864-7482
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR5020111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC514028Medicare PIN
COU87737Medicare UPIN