Provider Demographics
NPI:1902934136
Name:GROSSO, PETER EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWARD
Last Name:GROSSO
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 1:6544 W THOMAS RD
Mailing Address - Street 2:SUITE #37
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5738
Mailing Address - Country:US
Mailing Address - Phone:623-848-6000
Mailing Address - Fax:
Practice Address - Street 1:6544 W THOMAS RD
Practice Address - Street 2:SUITE # 37
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5738
Practice Address - Country:US
Practice Address - Phone:623-848-6000
Practice Address - Fax:623-748-4325
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor