Provider Demographics
NPI:1740348234
Name:GROSE, CHRISTOPHER M (DC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:M
Last Name:GROSE
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 1:1804A HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3331
Mailing Address - Country:US
Mailing Address - Phone:304-250-6047
Mailing Address - Fax:304-250-6048
Practice Address - Street 1:1804A HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3331
Practice Address - Country:US
Practice Address - Phone:304-250-6047
Practice Address - Fax:304-250-6048
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005398Medicaid
WV3810005398Medicaid
WV4171521Medicare PIN