Provider Demographics
NPI:1962573550
Name:GRAMZOW, AMY DANIELLE (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:DANIELLE
Last Name:GRAMZOW
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 1:38933 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3219
Mailing Address - Country:US
Mailing Address - Phone:586-468-5500
Mailing Address - Fax:586-468-5405
Practice Address - Street 1:38933 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3219
Practice Address - Country:US
Practice Address - Phone:586-468-5500
Practice Address - Fax:586-468-5405
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE05041002Medicare ID - Type Unspecified
MIU58353Medicare UPIN