MEDICARE: DR. ROBERT JAY GRUENENFELDER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC000619	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00056709	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11366966	OTHER	TN	CAQH ID
2	4067808	OTHER	TN	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639177330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JAY GRUENENFELDER D.C.

Provider Business Mailing Address
First Line	:	711 HIGHWAY 68
Second Line	:
City	:	SWEETWATER
State	:	TN
Zip	:	37874-1926
Country	:	US
Telephone Number	:	423-337-3761
Fax Number	:	423-337-9705

Provider Business Practice Location Address
First Line	:	711 HIGHWAY 68
Second Line	:
City	:	SWEETWATER
State	:	TN
Zip	:	37874-1926
Country	:	US
Telephone Number	:	423-337-3761
Fax Number	:	423-337-9705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/25/2011

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