Provider Demographics
NPI:1548320526
Name:GROCHOWSKI, GREGORY J (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:GROCHOWSKI
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 1:2408 ASHLEY RIVER RD UNIT Z
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-4619
Mailing Address - Country:US
Mailing Address - Phone:843-266-7534
Mailing Address - Fax:
Practice Address - Street 1:2408 ASHLEY RIVER RD UNIT Z
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-4619
Practice Address - Country:US
Practice Address - Phone:843-266-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4055111N00000X
CADC24388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U74624Medicare UPIN
DC0243880Medicare ID - Type Unspecified