Provider Demographics
NPI:1881938769
Name:GRONDIN CHIROPRACTIC, PA, INC.
Entity type:Organization
Organization Name:GRONDIN CHIROPRACTIC, PA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-740-0230
Mailing Address - Street 1:1223 US ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-3810
Mailing Address - Country:US
Mailing Address - Phone:207-377-9344
Mailing Address - Fax:207-377-4286
Practice Address - Street 1:1223 US ROUTE 202
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-3810
Practice Address - Country:US
Practice Address - Phone:207-377-9344
Practice Address - Fax:207-377-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty