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General NPI Number Information
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NPI Number | 1093848855
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Entity Type | Organization
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Legal Business Name | GRUMISH CHIROPRACTIC OFFICES
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40 BRIARCLIFF PROFESSIONAL CENTER
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1775
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Country | US
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Telephone | 815-939-0990
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Fax | 815-939-0822
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Provider Business Mailing Address
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Address Line | 40 BRIARCLIFF PROFESSIONAL CENTER
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1775
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Country | US
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Telephone | 815-939-0990
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Fax | 815-939-0822
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Authorized Official
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Title or Position | DIRECTOR OWNER
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Name | DR. JOHN PAUL GRUMISH
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Credential | DC
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Telephone | 815-939-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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