Provider Demographics
NPI:1770794463
Name:GROB, ALICE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MARIE
Last Name:GROB
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 1:515 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6748
Mailing Address - Country:US
Mailing Address - Phone:310-686-0370
Mailing Address - Fax:
Practice Address - Street 1:515 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6748
Practice Address - Country:US
Practice Address - Phone:310-686-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor