MEDICARE: MR. DAVID J GROSSI 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	DC003012L	PA
2	111N00000X	Chiropractor	0104000646	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	605242	OTHER		BLUESHIELD (HIGHMARK)

General Provider Information

NPI Number	:	1124024781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID J GROSSI DC

Provider Business Mailing Address
First Line	:	842 LAUREL ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3592
Country	:	US
Telephone Number	:	724-349-7710
Fax Number	:	724-349-8996

Provider Business Practice Location Address
First Line	:	842 LAUREL ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3592
Country	:	US
Telephone Number	:	724-349-7710
Fax Number	:	724-349-8996

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. DAVID J GROSSI DC” Practice Location

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