MEDICARE: GREGORY S GRUBA DC

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	735	SD

General Provider Information

NPI Number	:	1063485720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY S GRUBA DC

Provider Business Mailing Address
First Line	:	402 SAINT JOSEPH ST STE 2
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3081
Country	:	US
Telephone Number	:	605-791-1770
Fax Number	:	605-791-2368

Provider Business Practice Location Address
First Line	:	402 SAINT JOSEPH ST STE 2
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3081
Country	:	US
Telephone Number	:	605-791-1770
Fax Number	:	605-791-2368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	06/05/2020

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