Provider Demographics
NPI:1861138646
Name:GRUBISH, ALEX DAVID (DC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:DAVID
Last Name:GRUBISH
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 1:1495 GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1537
Mailing Address - Country:US
Mailing Address - Phone:740-404-6487
Mailing Address - Fax:
Practice Address - Street 1:1495 GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1537
Practice Address - Country:US
Practice Address - Phone:740-404-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5759-12111N00000X
OHDC-05418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor