Provider Demographics
NPI:1912124397
Name:GROELZ, RYAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:GROELZ
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 1:413 SUMMIT BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8295
Mailing Address - Country:US
Mailing Address - Phone:303-499-6565
Mailing Address - Fax:303-499-8585
Practice Address - Street 1:413 SUMMIT BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8295
Practice Address - Country:US
Practice Address - Phone:303-499-6565
Practice Address - Fax:303-499-8585
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC521028Medicare PIN