Healthcare Provider Details

I. General information

NPI: 1720274749
Provider Name (Legal Business Name): GROSKOPP CHIROPRACTIC, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W RYAN ST
BRILLION WI
54110-1045
US

IV. Provider business mailing address

708 W RYAN ST
BRILLION WI
54110-1045
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-2151
  • Fax: 920-756-3434
Mailing address:
  • Phone: 920-756-2151
  • Fax: 920-756-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1608012
License Number StateWI

VIII. Authorized Official

Name: DAVID DONALD MEYER
Title or Position: OWNER
Credential: DC
Phone: 920-756-2151