Provider Demographics
NPI:1750454724
Name:GROTHE, CYNTHIA ANN (DC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:GROTHE
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52623-0236
Mailing Address - Country:US
Mailing Address - Phone:319-392-8567
Mailing Address - Fax:319-392-4553
Practice Address - Street 1:204 N MAIN ST # 236
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IA
Practice Address - Zip Code:52623-9620
Practice Address - Country:US
Practice Address - Phone:319-392-8567
Practice Address - Fax:319-392-4553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA40653Medicare PIN