Provider Demographics
NPI:1336233683
Name:GROFF, MARK BOYD (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BOYD
Last Name:GROFF
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 1:1167 NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-451-3400
Mailing Address - Fax:615-451-3544
Practice Address - Street 1:1167 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-451-3400
Practice Address - Fax:615-451-3544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2052943OtherAETNA
TN5651996OtherCIGNA
TN3092896OtherBCBS OF TN
TN44-40329OtherUHC
TN3092896OtherBCBS OF TN
TN5651996OtherCIGNA