Provider Demographics
NPI:1104961572
Name:BORSETH-GRUBB, ANN R (DC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:R
Last Name:BORSETH-GRUBB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:R
Other - Last Name:HAUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2912 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TRURO
Mailing Address - State:IA
Mailing Address - Zip Code:50257-8004
Mailing Address - Country:US
Mailing Address - Phone:515-360-9310
Mailing Address - Fax:515-440-3062
Practice Address - Street 1:1441 29TH ST STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1309
Practice Address - Country:US
Practice Address - Phone:515-360-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0203927Medicaid
IA49624Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER