Provider Demographics
NPI:1801986252
Name:GRONSKI, ROBERT SCOTT (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:GRONSKI
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 1:223 W PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4903
Mailing Address - Country:US
Mailing Address - Phone:262-334-1011
Mailing Address - Fax:262-338-0306
Practice Address - Street 1:223 W PARADISE DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-4903
Practice Address - Country:US
Practice Address - Phone:262-334-1011
Practice Address - Fax:262-338-0306
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2539012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38863700Medicaid
U20786Medicare UPIN
WI38863700Medicaid