Provider Demographics
NPI:1366596900
Name:GRUENDLER, ANISSA (DC)
Entity type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:
Last Name:GRUENDLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N WALNUT ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1768
Mailing Address - Country:US
Mailing Address - Phone:574-941-2225
Mailing Address - Fax:574-941-2225
Practice Address - Street 1:304 N WALNUT ST
Practice Address - Street 2:SUITE 115
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1768
Practice Address - Country:US
Practice Address - Phone:574-941-2225
Practice Address - Fax:574-941-2225
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN226730Medicare ID - Type UnspecifiedMEDICARE