Provider Demographics
NPI:1205508611
Name:GROSSO, CAROLINE MARIA (DO)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIA
Last Name:GROSSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3115 IVYDALE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5730
Mailing Address - Country:US
Mailing Address - Phone:607-765-3610
Mailing Address - Fax:704-544-5382
Practice Address - Street 1:5950 FAIRVIEW RD STE 218
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3152
Practice Address - Country:US
Practice Address - Phone:704-544-5353
Practice Address - Fax:704-544-5382
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor