Provider Demographics
NPI:1992999353
Name:GRUSKY CHIROPRACTIC HEALTH CENTER PA
Entity type:Organization
Organization Name:GRUSKY CHIROPRACTIC HEALTH CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:GRUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-421-2355
Mailing Address - Street 1:3836 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442
Mailing Address - Country:US
Mailing Address - Phone:954-421-2355
Mailing Address - Fax:954-421-6455
Practice Address - Street 1:3836 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442
Practice Address - Country:US
Practice Address - Phone:954-421-2355
Practice Address - Fax:954-421-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU28890Medicare UPIN
FL99674AMedicare PIN