MEDICARE: GBC GROTTS INC.

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	5020	CO

General Provider Information

NPI Number	:	1285672170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBC GROTTS INC.

Provider Business Mailing Address
First Line	:	1150 N 25TH ST
Second Line	:	STE D
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-6594
Country	:	US
Telephone Number	:	970-245-6513
Fax Number	:	970-245-6599

Provider Business Practice Location Address
First Line	:	1150 N 25TH ST
Second Line	:	STE D
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-6594
Country	:	US
Telephone Number	:	970-245-6513
Fax Number	:	970-245-6599

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY GROTTS
Credential	:
Telephone Number	:	370-245-6513

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/05/2015

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