Provider Demographics
NPI:1780910224
Name:GROSTIC CHIROPRACTIC, PC
Entity type:Organization
Organization Name:GROSTIC CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GROSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-317-7583
Mailing Address - Street 1:2752 WATTS DR NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2721
Mailing Address - Country:US
Mailing Address - Phone:678-401-6256
Mailing Address - Fax:
Practice Address - Street 1:2752 WATTS DR NW
Practice Address - Street 2:SUITE A
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2721
Practice Address - Country:US
Practice Address - Phone:678-401-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty