Healthcare Provider Details

I. General information

NPI: 1437366556
Provider Name (Legal Business Name): MARIE T GROTHMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N LAKE ST STE 1
AURORA IL
60506-3178
US

IV. Provider business mailing address

1460 WILMETTE ST
WHEATON IL
60187-3712
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-1244
  • Fax: 630-844-1199
Mailing address:
  • Phone: 630-665-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: