MEDICARE: COREY J GRINK 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	DC007659L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	811029	OTHER	PA	FIRST PRIORITY
2	0784811000	OTHER	PA	AMERIHEALTH
3	7310472	OTHER	PA	AETNA PPO/POS
4	1726279	OTHER	PA	AETNA HMO
5	1038611	OTHER	PA	ASHN

General Provider Information

NPI Number	:	1922065978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY J GRINK D.C.

Provider Business Mailing Address
First Line	:	2325 MARYLAND RD
Second Line	:	SUITE 200
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1749
Country	:	US
Telephone Number	:	215-657-9393
Fax Number	:	215-657-9398

Provider Business Practice Location Address
First Line	:	2325 MARYLAND RD
Second Line	:	SUITE 200
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1749
Country	:	US
Telephone Number	:	215-657-9393
Fax Number	:	215-657-9398

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/18/2008

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Directions to “ COREY J GRINK D.C.” Practice Location

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