Healthcare Provider Details

I. General information

NPI: 1083163372
Provider Name (Legal Business Name): GROERICH CHIROPRACTIC AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD STE 300B
RICHMOND HEIGHTS MO
63117-1203
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD STE 300B
RICHMOND HEIGHTS MO
63117-1203
US

V. Phone/Fax

Practice location:
  • Phone: 314-456-2761
  • Fax: 314-644-2309
Mailing address:
  • Phone: 314-456-2761
  • Fax: 314-644-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2015001863
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN GROERICH
Title or Position: OWNER
Credential: DC
Phone: 314-456-2761