Healthcare Provider Details

I. General information

NPI: 1497767909
Provider Name (Legal Business Name): WILLIAM CHARLES GROSKOPP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MAIN ST SUITE 3
BRILLION WI
54110-1197
US

IV. Provider business mailing address

205 N MAIN ST SUITE 3
BRILLION WI
54110-1197
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-2151
  • Fax: 920-756-2152
Mailing address:
  • Phone: 920-756-2151
  • Fax: 920-756-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1608-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: