Provider Demographics
NPI:1013695303
Name:GROSE, CALEB LEE (DC)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:LEE
Last Name:GROSE
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 1:1905 EP TRUE PARKWARY # 207
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265
Mailing Address - Country:US
Mailing Address - Phone:515-309-3791
Mailing Address - Fax:
Practice Address - Street 1:1905 EP TRUE PARKWARY # 207
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265
Practice Address - Country:US
Practice Address - Phone:515-309-3791
Practice Address - Fax:515-309-3792
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor