Healthcare Provider Details

I. General information

NPI: 1679570758
Provider Name (Legal Business Name): KEVIN K GRUHOT D.C., D.A.B.C.O., C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 19TH AVE S
GRAND FORKS ND
58201-5957
US

IV. Provider business mailing address

2840 19TH AVE S
GRAND FORKS ND
58201-5957
US

V. Phone/Fax

Practice location:
  • Phone: 701-772-2670
  • Fax: 701-772-2706
Mailing address:
  • Phone: 701-772-2670
  • Fax: 701-772-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number516
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: