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General NPI Number Information
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NPI Number | 1700207149
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Entity Type | Individual
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Provider Name | JON GRISSMAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 430 S BROAD ST SUITE 130
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City | MANKATO
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State | MN
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Zip | 56001-3789
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Country | US
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Telephone | 507-387-5591
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Fax | 507-387-5397
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Provider Business Mailing Address
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Address Line | 430 S BROAD ST STE 130
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City | MANKATO
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State | MN
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Zip | 56001-3796
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Country | US
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Telephone | 507-387-5591
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Fax | 507-205-2838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5863
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License Number State | MN
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