Provider Demographics
NPI:1912928706
Name:GROSSO, CYNTHIA RAE (DC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RAE
Last Name:GROSSO
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 1:615 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-736-1680
Mailing Address - Fax:413-736-6057
Practice Address - Street 1:615 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-736-1680
Practice Address - Fax:413-736-6057
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101894OtherCIGNA
MA350048372OtherMEDICARE RAILROAD
MA351283OtherHPHC
MAY36506OtherBCBS MA
MA2316916OtherAETNA
MAY45150Medicare PIN
MAY36506OtherBCBS MA