Organization
GRIESBAUM FAMILY CHIROPRACTIC S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY JOSEPH GRIESBAUM D.C. (OWNER)
(309) 268-9888
Entity
Organization
Contact information
Practice address
1607 VISA DR, 1A, NORMAL, IL 61761-2137
(309) 268-9888
(309) 268-9887
Mailing address
1607 VISA DR, 1A, NORMAL, IL 61761-2137
(309) 268-9888
(309) 268-9887
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038008016
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05722922
BLUE CROSS BLUE SHIELD
IL
01
—
350046480
RAILROAD MEDICARE
IL
Enumeration date
06/22/2011
Last updated
02/10/2012
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