Provider Demographics
NPI:1154394666
Name:GRUNST, SHEILA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:MARIE
Last Name:GRUNST
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRYANT AVE SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1544
Mailing Address - Country:US
Mailing Address - Phone:218-631-3382
Mailing Address - Fax:218-634-3479
Practice Address - Street 1:10 BRYANT AVE SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1544
Practice Address - Country:US
Practice Address - Phone:218-631-3382
Practice Address - Fax:218-634-3479
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN394328300Medicaid
MN359000768Medicare ID - Type Unspecified
MNU08385Medicare UPIN