Healthcare Provider Details

I. General information

NPI: 1972657344
Provider Name (Legal Business Name): JUSTIN M GRUBY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 GLENVIEW RD 2ND FLOOR
GLENVIEW IL
60025-6921
US

IV. Provider business mailing address

1834 GLENVIEW RD 2ND FLOOR
GLENVIEW IL
60025-6921
US

V. Phone/Fax

Practice location:
  • Phone: 847-845-5984
  • Fax: 847-486-1146
Mailing address:
  • Phone: 847-845-5984
  • Fax: 847-486-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: