Individual
MR. KEVIN P GROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1540 HERITAGE BLVD, SUITE 203, WEST SALEM, WI 54669
(608) 786-3670
(608) 786-3672
Mailing address
1540 HERITAGE BLVD., SUITE 203, WEST SALEM, WI 54669
(608) 786-3670
(608) 786-3672
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4109-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38959600
—
WI
01
—
P00600195
MEDICARE RAILROAD
WI
Enumeration date
07/18/2006
Last updated
10/14/2015
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