Provider Demographics
NPI:1134157290
Name:GRAUPMANN, TIMOTHY RAYMOND (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:GRAUPMANN
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:GRAND RAPIDS CHIROPRACTIC
Mailing Address - Street 2:2610 SOUTH HWY 169
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744
Mailing Address - Country:US
Mailing Address - Phone:218-326-1030
Mailing Address - Fax:218-326-6927
Practice Address - Street 1:GRAND RAPIDS CHIROPRACTIC 2610 S HWY 169
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744
Practice Address - Country:US
Practice Address - Phone:218-326-1030
Practice Address - Fax:218-326-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN074K4GROtherBLUECROSS/BLUESHIELD
MN4400388OtherMEDICA
MN596228500Medicaid
MN596228500Medicaid
MN4400388OtherMEDICA