Provider Demographics
NPI:1184794026
Name:GRUDA, DAVID THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:GRUDA
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 1:190 W PARK AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2277
Mailing Address - Country:US
Mailing Address - Phone:814-371-6266
Mailing Address - Fax:814-371-1161
Practice Address - Street 1:190 W PARK AVE STE 5
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2277
Practice Address - Country:US
Practice Address - Phone:814-371-6266
Practice Address - Fax:814-371-1161
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002316L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor