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General NPI Number Information
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NPI Number | 1356637938
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Entity Type | Organization
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Legal Business Name | GRIESBAUM FAMILY CHIROPRACTIC S C
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 1607 VISA DR 1A
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City | NORMAL
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State | IL
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Zip | 61761-2137
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Country | US
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Telephone | 309-268-9888
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Fax | 309-268-9887
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Provider Business Mailing Address
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Address Line | 1607 VISA DR 1A
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City | NORMAL
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State | IL
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Zip | 61761-2137
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Country | US
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Telephone | 309-268-9888
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Fax | 309-268-9887
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY JOSEPH GRIESBAUM
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Credential | D.C.
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Telephone | 309-268-9888
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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 | 038008016
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License Number State | IL
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