Healthcare Provider Details

I. General information

NPI: 1194115998
Provider Name (Legal Business Name): JOHN GROERICH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2015
Last Update Date: 09/13/2016
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:
Title or Position:
Credential:
Phone: