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Organization
COMMUNITY CHIROPRACTIC CORP.
Active
Organization
COMMUNITY CHIROPRACTIC CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL V. GRUNERT D.C. (PRESIDENT/CEO)
(815) 609-6150
Entity
Organization
Contact information
Practice address
127 CAPISTA DR., SHOREWOOD, IL 60404-8551
(815) 609-6150
(219) 203-2925
Mailing address
127 CAPISTA DR., SHOREWOOD, IL 60404-8551
(815) 609-6150
(219) 203-2925
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038007034
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04915367
BLUE SHIELD
IL
Enumeration date
09/02/2005
Last updated
11/03/2014
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