Provider Demographics
NPI:1861415556
Name:GROB, STEVEN DAVID (DC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:GROB
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 1:1057 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4220
Mailing Address - Country:US
Mailing Address - Phone:860-445-4148
Mailing Address - Fax:860-449-1375
Practice Address - Street 1:1057 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4220
Practice Address - Country:US
Practice Address - Phone:860-445-4148
Practice Address - Fax:860-449-1375
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT070213OtherACN
CT1031257OtherASHN
CT05000397CT01OtherANTHEM BLUE CROSS
CT10443909OtherCAQH
CTNLS066OtherTRIAD/OXFORD
CTOV4644OtherLANDMARK/HEALTHNET
CT4569279OtherAETNA
CT44-00115OtherUNITED HEALTHCARE
CT10443909OtherCAQH