Healthcare Provider Details

I. General information

NPI: 1639182520
Provider Name (Legal Business Name): MARTIN ALLEN GROSSMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE STE 205
COCONUT GROVE FL
33133-2740
US

IV. Provider business mailing address

2780 SW 37TH AVE STE 205
COCONUT GROVE FL
33133-2740
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-1095
  • Fax: 305-446-1410
Mailing address:
  • Phone: 305-446-1095
  • Fax: 305-446-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0003142
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: