Healthcare Provider Details

I. General information

NPI: 1790723567
Provider Name (Legal Business Name): ADAM DANIEL GROSSMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 RIDGE RD STE 2
DAYTON NJ
08810-1715
US

IV. Provider business mailing address

397 RIDGE RD STE 2
DAYTON NJ
08810-1715
US

V. Phone/Fax

Practice location:
  • Phone: 732-438-8700
  • Fax: 732-438-8705
Mailing address:
  • Phone: 732-438-8700
  • Fax: 732-438-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00646300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: