Provider Demographics
NPI:1861424541
Name:GRUBB, TODD E (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:GRUBB
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 1:116 N MAIN ST
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:CAPAC
Mailing Address - State:MI
Mailing Address - Zip Code:48014
Mailing Address - Country:US
Mailing Address - Phone:810-395-2679
Mailing Address - Fax:810-395-8809
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CAPAC
Practice Address - State:MI
Practice Address - Zip Code:48014
Practice Address - Country:US
Practice Address - Phone:810-395-2679
Practice Address - Fax:810-395-8809
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OG45056OtherBLUE CROSS
OG45056OtherBLUE CROSS