Healthcare Provider Details

I. General information

NPI: 1225870736
Provider Name (Legal Business Name): GRUEN CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADWAY RM 1213
NEW YORK NY
10038-4403
US

IV. Provider business mailing address

150 BROADWAY RM 1213
NEW YORK NY
10038-4403
US

V. Phone/Fax

Practice location:
  • Phone: 646-664-1891
  • Fax:
Mailing address:
  • Phone: 646-664-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: BEN GRUEN
Title or Position: DC
Credential:
Phone: 646-664-1891