Provider Demographics
NPI:1841269594
Name:GRUMET, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GRUMET
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 1:666 DUNDEE RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2727
Mailing Address - Country:US
Mailing Address - Phone:847-897-8888
Mailing Address - Fax:
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:SUITE 307
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-897-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628196OtherBCBSIL
ILK21258Medicare ID - Type Unspecified
U86505Medicare UPIN