=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861537383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE GRUBER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6506 WOLLOCHET DR. NW BLDG. B
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-853-3353
-----------------------------------------------------
Fax | 253-858-1552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6506 WOLLOCHET DR. NW BLDG. B
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-853-3353
-----------------------------------------------------
Fax | 253-858-1552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00003198
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------