Provider Demographics
NPI:1972657344
Name:GRUBY, JUSTIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:GRUBY
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:1834 GLENVIEW RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6921
Mailing Address - Country:US
Mailing Address - Phone:847-845-5984
Mailing Address - Fax:847-486-1146
Practice Address - Street 1:1834 GLENVIEW RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-6921
Practice Address - Country:US
Practice Address - Phone:847-845-5984
Practice Address - Fax:847-486-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL111NN1001X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV11357Medicare UPIN