Provider Demographics
NPI:1902630221
Name:GROTELUSCHEN, NEAL (DC)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:
Last Name:GROTELUSCHEN
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 1:8304 WILDEN DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-7067
Mailing Address - Country:US
Mailing Address - Phone:515-991-6811
Mailing Address - Fax:
Practice Address - Street 1:8304 WILDEN DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7067
Practice Address - Country:US
Practice Address - Phone:515-991-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor