MEDICARE: GROSSMAN CHIROPRACTIC & PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00646300	NJ

General Provider Information

NPI Number	:	1043265879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROSSMAN CHIROPRACTIC & PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	397 RIDGE RD STE 2
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-1715
Country	:	US
Telephone Number	:	732-438-8700
Fax Number	:	732-438-8705

Provider Business Practice Location Address
First Line	:	397 RIDGE RD STE 2
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-1715
Country	:	US
Telephone Number	:	732-438-8700
Fax Number	:	732-438-8705

Authorized Official
Title or Position	:	OWNER
Name	:	ADAM DANIEL GROSSMAN
Credential	:	DC
Telephone Number	:	732-438-8700

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/24/2018

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