Provider Demographics
NPI:1861796559
Name:GRABOUSKI, JUSTIN PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:PAUL
Last Name:GRABOUSKI
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 1:9154 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2044
Mailing Address - Country:US
Mailing Address - Phone:913-851-5188
Mailing Address - Fax:855-691-7040
Practice Address - Street 1:9154 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-2044
Practice Address - Country:US
Practice Address - Phone:913-851-5188
Practice Address - Fax:855-691-7040
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor