Provider Demographics
NPI:1194115998
Name:GROERICH, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GROERICH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1034 S BRENTWOOD BLVD
Mailing Address - Street 2:STE 300B
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1203
Mailing Address - Country:US
Mailing Address - Phone:314-456-2761
Mailing Address - Fax:314-644-2309
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:STE 300B
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1203
Practice Address - Country:US
Practice Address - Phone:314-456-2761
Practice Address - Fax:314-644-2309
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015001863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor