Provider Demographics
NPI:1013978980
Name:SMITH GROZALIS, JENNIFER (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SMITH GROZALIS
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 1:1424 HEATHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3732
Mailing Address - Country:US
Mailing Address - Phone:215-504-0811
Mailing Address - Fax:
Practice Address - Street 1:680 HEACOCK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6346
Practice Address - Country:US
Practice Address - Phone:215-321-9798
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007698L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2437145OtherAETNA HMO
PA0083599000OtherBLUE SHIELD
PA7881159OtherAETNA TRADITIONAL PIN
PA000172371OtherIND BLUE CROSS
PA2437145OtherAETNA HMO