Healthcare Provider Details

I. General information

NPI: 1073646121
Provider Name (Legal Business Name): GRUNST CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRYANT AVE SE
WADENA MN
56482-1544
US

IV. Provider business mailing address

10 BRYANT AVE SE
WADENA MN
56482-1544
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-3382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2831
License Number StateMN

VIII. Authorized Official

Name: DR. JEFFREY ALAN GRUNST
Title or Position: OWNER
Credential: D.C.
Phone: 218-631-3382