Provider Demographics
NPI:1881026128
Name:GRUND CHIROPRACT HEALTH CENTER
Entity type:Organization
Organization Name:GRUND CHIROPRACT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC,DACNB
Authorized Official - Phone:707-575-5577
Mailing Address - Street 1:182 FARMERS LN STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4761
Mailing Address - Country:US
Mailing Address - Phone:707-575-5577
Mailing Address - Fax:707-575-5579
Practice Address - Street 1:182 FARMERS LN STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4761
Practice Address - Country:US
Practice Address - Phone:707-575-5577
Practice Address - Fax:707-575-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty