MEDICARE: A. GRBICH 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	3936-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356371439	OTHER	WI	M.GRBICH,DC NPI#

General Provider Information

NPI Number	:	1487862751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. GRBICH LLC

Provider Business Mailing Address
First Line	:	4454 N 107TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53225-4525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	N88W16598 MAIN ST
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2845
Country	:	US
Telephone Number	:	262-502-0028
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MATTHEW JON GRBICH
Credential	:
Telephone Number	:	262-502-0028

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	08/22/2020

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Directions to “A. GRBICH LLC ” Practice Location

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