Provider Demographics
NPI:1811133937
Name:GROTZINGER, DANIEL LEE (DC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:GROTZINGER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N SECTION ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-1237
Mailing Address - Country:US
Mailing Address - Phone:812-268-3400
Mailing Address - Fax:812-268-5713
Practice Address - Street 1:102 S SPRING ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562-1314
Practice Address - Country:US
Practice Address - Phone:812-636-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000844A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor