Provider Demographics
NPI:1477670628
Name:GRUBE, ALYSSA SUE (DC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SUE
Last Name:GRUBE
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 1:1211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:PA
Mailing Address - Zip Code:17501-1636
Mailing Address - Country:US
Mailing Address - Phone:717-859-1090
Mailing Address - Fax:717-859-1907
Practice Address - Street 1:1211 MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1636
Practice Address - Country:US
Practice Address - Phone:717-859-1090
Practice Address - Fax:717-859-1907
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006286L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA893046Medicare UPIN