Provider Demographics
NPI:1871600684
Name:GROETZ, WILLIAM OSKAR (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:OSKAR
Last Name:GROETZ
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 1:6737 LONSDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-8747
Mailing Address - Country:US
Mailing Address - Phone:315-687-3154
Mailing Address - Fax:315-655-4626
Practice Address - Street 1:6737 LONSDALE RD
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8747
Practice Address - Country:US
Practice Address - Phone:315-687-3154
Practice Address - Fax:315-655-4626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO4429-9111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50201BMedicare ID - Type UnspecifiedMEDICARE PARTICIPANT NUMB